Toti Francesco, Di Pangrazio Marco, Pinto Federico, Martinino Alessandro, Zhang Lily, Johnson Colton, Bianco Francesco Maria, Giulianotti Pier Cristoforo
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.
Hepatobiliary Surg Nutr. 2025 Aug 1;14(4):575-586. doi: 10.21037/hbsn-24-379. Epub 2025 Jan 6.
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.
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.
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%.
The IWATE criteria effectively correlate with surgical outcomes in our series, providing a valuable tool for standardizing procedure complexity and facilitating outcome comparisons.
机器人肝脏切除术（RLR）在全球范围内的开展越来越多。岩手标准提供了一种标准化分类，以将这些手术的复杂性与手术结果相关联。本研究分析了一位外科医生的机器人肝脏切除术经验，并评估了岩手标准的适用性和相关性。
我们对2007年6月至2023年5月在伊利诺伊大学芝加哥分校由一位外科医生实施的188例机器人肝脏切除术进行了回顾性分析。收集了患者人口统计学、手术细节、病理学以及30天发病率和死亡率的数据。手术数据包括手术时长、失血量、中转率、术中和围手术期并发症以及住院时间（LOS）。根据岩手标准将患者分为四组。
除年龄和术前化疗率有显著差异外，患者在四组中的分布较为均匀。手术时间（OT）和估计失血量（EBL）随手术复杂性增加而增加，范围从148分钟至350分钟以及75毫升至400毫升（P<0.001）。有18例中转（9.6%），专家组和高级组的中转率显著更高（P<0.001）。术中输血情况也呈现相同模式。术后结果显示中位住院时间有显著差异（P<0.001），从3天至7天不等（低级别组至专家组）。有8例主要并发症，再入院率为3.7%，无30天死亡率，且各组间并发症分布无显著差异。总体R0切除率为96.3%。
在我们的系列研究中，岩手标准与手术结果有效相关，为标准化手术复杂性和促进结果比较提供了一个有价值的工具。
