Takagi Kosei, Fuji Tomokazu, Yasui Kazuya, Umeda Yuzo, Yamada Motohiko, Nishiyama Takeyoshi, Nagai Yasuo, Kanehira Noriyuki, Fujiwara Toshiyoshi
Department of Gastroenterological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Department of Hepatobiliary Pancreatic Surgery, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.
World J Surg Oncol. 2025 Apr 7;23(1):124. doi: 10.1186/s12957-025-03785-3.
Internationally, evidence supporting robotic liver resection (RLR) has gradually increased in recent years. However, a standardized protocol for RLR remains lacking. This study describes a surgical protocol and the initial outcomes of RLR in a high-volume center for robotic hepatopancreatobiliary surgery in Japan.
Patients were placed in the reverse Trendelenburg position, with a supine position for anterolateral tumors and left lateral position for posterosuperior tumors. Our standard RLR protocol involved a two-surgeon technique. Liver parenchymal transection was performed by an assistant using the clamp crush technique with a console, with or without a laparoscopic Cavitron ultrasonic surgical aspirator (CUSA). Surgical techniques, including the tips, tricks, and pitfalls of RLR, are also demonstrated.
We performed 113 RLR at our institution for common primary diseases, including hepatocellular carcinoma (n = 52, 46.0%) and metastatic tumors (n = 48, 42.5%) between July 2022 and December 2024. The median operative time and estimated blood loss were 156 min (interquartile range [IQR], 121-209 min) and 20 mL (IQR, 0-100 mL), respectively. During liver parenchymal transection, a laparoscopic CUSA was used in 59 patients (52.2%), and a water-jet scalpel was used in 12 patients (10.6%). The incidence of mortality, major complications, and bile leakage was 0%, 6.2%, and 2.7%, respectively. The median hospital stay was 7 days (IQR, 6-9 days).
We successfully introduced an RLR program using the two-surgeon technique. Safe implementation of RLR can be achieved upon completion of the training program and thorough understanding of the surgical protocols.
近年来，国际上支持机器人肝切除术（RLR）的证据逐渐增多。然而，RLR仍缺乏标准化方案。本研究描述了日本一家高容量机器人肝胆胰手术中心的RLR手术方案及初步结果。
患者取反向头低脚高位，前外侧肿瘤取仰卧位，后上侧肿瘤取左侧卧位。我们的标准RLR方案采用双术者技术。肝实质离断由助手使用控制台的钳夹挤压技术进行，可使用或不使用腹腔镜超声外科吸引器（CUSA）。还展示了RLR的手术技术，包括技巧、窍门和陷阱。
2022年7月至2024年12月期间，我们机构对包括肝细胞癌（n = 52，46.0%）和转移性肿瘤（n = 48，42.5%）在内的常见原发性疾病进行了113例RLR。中位手术时间和估计失血量分别为156分钟（四分位间距[IQR]，121 - 209分钟）和20毫升（IQR，0 - 100毫升）。在肝实质离断过程中，59例患者（52.2%）使用了腹腔镜CUSA，12例患者（10.6%）使用了水刀。死亡率、主要并发症发生率和胆漏发生率分别为0%、6.2%和2.7%。中位住院时间为7天（IQR，6 - 9天）。
我们成功引入了采用双术者技术的RLR项目。完成培训项目并透彻理解手术方案后，可实现RLR的安全实施。
