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Evaluation of outcomes of robotic liver surgery using the IWATE criteria.

作者信息

Toti Francesco, Di Pangrazio Marco, Pinto Federico, Martinino Alessandro, Zhang Lily, Johnson Colton, Bianco Francesco Maria, Giulianotti Pier Cristoforo

机构信息

Division of General Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.

University of Illinois at Chicago College of Medicine, Chicago, IL, USA.

出版信息

Hepatobiliary Surg Nutr. 2025 Aug 1;14(4):575-586. doi: 10.21037/hbsn-24-379. Epub 2025 Jan 6.


DOI:10.21037/hbsn-24-379
PMID:40893753
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12393123/
Abstract

BACKGROUND: Robotic liver resections (RLRs) are increasingly performed worldwide. The IWATE criteria offer a standardized classification to correlate the complexity of these procedures with surgical outcomes. This study analyzes a single surgeon's experience with RLR and evaluates the applicability and correlation of the IWATE criteria. METHODS: We conducted a retrospective analysis of 188 RLRs performed by a single surgeon at the University of Illinois at Chicago from June 2007 to May 2023. Data on patient demographics, surgical details, pathology, and 30-day morbidity and mortality were collected. Surgical data included operation duration, blood loss, conversion rates, intraoperative and perioperative complications, and length of hospital stay (LOS). Patients were categorized into four groups according to the IWATE criteria. RESULTS: Patients were evenly distributed across the four groups, except for age and preoperative chemotherapy rates, which were significantly different. Operative times (OTs) and estimated blood loss (EBL) increased with procedure complexity, ranging from 148 to 350 minutes and 75 to 400 mL (P<0.001). There were 18 conversions (9.6%), with a significantly higher rate in the Expert and Advanced groups (P<0.001). Intraoperative transfusions followed the same pattern. Postoperative outcomes showed a significant difference in median hospital stay (P<0.001), varying from 3 to 7 days (Low to Expert groups). There were 8 major complications and a 3.7% readmission rate, with no 30-day mortality, and no significant difference in complication distribution among groups. The overall R0 resection rate was 96.3%. CONCLUSIONS: The IWATE criteria effectively correlate with surgical outcomes in our series, providing a valuable tool for standardizing procedure complexity and facilitating outcome comparisons.

摘要

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本文引用的文献

[1]
Upfront laparotomy versus conversion from minimally invasive surgery to open surgery in colon cancer: Is there a difference in outcomes?

Surgery. 2024-7

[2]
The death of laparoscopy.

Surg Endosc. 2024-5

[3]
Robotic versus laparoscopic liver resections: propensity-matched comparison of two-center experience.

Surg Endosc. 2023-10

[4]
Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma.

JAMA Surg. 2023-1-1

[5]
Based on the IWATE criteria: to investigate the influence of different surgical approaches on the perioperative outcomes of hepatectomy.

Surg Endosc. 2023-2

[6]
Short-term outcomes of robotic liver resection: An initial single-institution experience.

World J Hepatol. 2022-1-27

[7]
Validation of the IWATE criteria as a laparoscopic liver resection difficulty score in a single North American cohort.

Surg Endosc. 2022-5

[8]
IWATE criteria are associated with perioperative outcomes in robotic hepatectomy: a retrospective review of 225 resections.

Surg Endosc. 2022-2

[9]
Applying IWATE criteria to robotic hepatectomy: is there a "robotic effect"?

HPB (Oxford). 2021-6

[10]
Robotic Major Hepatectomy: An Institutional Experience and Clinical Outcomes.

Ann Surg Oncol. 2020-12

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