Pasquale Alessio, Ciarleglio Francesco A, Marinelli Laura, Viel Giovanni, Valcanover Stefano, Salimian Nick, Marcucci Stefano, Brolese Marco, Beltempo Paolo, Brolese Alberto
Department of General Surgery, Hepato-Pancreato-Biliary (HPB) Unit-Azienda Provinciale per i Servizi Sanitari APSS, 38121 Trento, Italy.
Department of General Surgery-Azienda Provinciale per i Servizi Sanitari APSS, 38023 Cles, Italy.
J Clin Med. 2025 Sep 17;14(18):6530. doi: 10.3390/jcm14186530.
Robotic liver resection (RLR) has seen remarkable advancements in recent years, overcoming many limitations of laparoscopic liver resection (LLR). RLR has evolved to include increasingly complex procedures, offering enhanced precision, reduced blood loss, and lower complication rates. A total of 150 consecutive RLRs, performed at the Department of General Surgery II and HPB Unit of Santa Chiara Hospital (Trento, Italy), between January 2013 and June 2024 were retrospectively reviewed. Collected data included demographics, disease etiology, operative parameters, oncologic margins, and perioperative outcomes. Indications were malignant disease in 83% of cases while benign disease accounted for 17%. Minor resections accounted for 91%. Cirrhosis was present in 49% of patients (Child-Pugh A 91%; B 9%; mean MELD 9). According to the Iwate difficulty score, resections were low difficulty in 38% of cases, intermediate in 50%, advanced in 7%, expert in 5%. Conversion rate was 12%, mainly for bleeding or adhesions. Mean blood loss was 159 mL (66% <100 mL); Pringle maneuver was used in 3%; drains omitted in 45%; ICG fluorescence used in 81%. Mean operative time was 250 min (console time 184 min). Mean lesion size was 34 mm; R0 margin rate was 82%. Overall mortality was 1.3%; morbidity 24% (Clavien-Dindo ≥ III in 10%). Mean hospital stay was 7 days (median 5; range 2-46). RLR is a safe and effective alternative to laparoscopy, providing comparable or superior perioperative outcomes. Medium-volume centers can achieve high-quality results with RLR. Continued technological advancements will further expand its applications to increasingly complex liver procedures.
近年来，机器人肝切除术（RLR）取得了显著进展，克服了腹腔镜肝切除术（LLR）的许多局限性。RLR已发展到包括越来越复杂的手术，具有更高的精准度、更少的失血和更低的并发症发生率。对2013年1月至2024年6月期间在意大利特伦托圣基亚拉医院普通外科II和肝脏胰胆科连续进行的150例RLR进行了回顾性研究。收集的数据包括人口统计学、疾病病因、手术参数、肿瘤切缘和围手术期结果。83%的病例为恶性疾病，良性疾病占17%。小范围切除术占91%。49%的患者存在肝硬化（Child-Pugh A级91%；B级9%；平均终末期肝病模型评分9）。根据岩手难度评分，38%的病例为低难度切除，50%为中等难度，7%为高难度，5%为专家级难度。中转率为12%，主要原因是出血或粘连。平均失血量为159毫升（66%＜100毫升）；3%的手术使用了Pringle手法；45%的手术未放置引流管；81%的手术使用了吲哚菁绿荧光。平均手术时间为250分钟（控制台操作时间184分钟）。平均病变大小为34毫米；R0切缘率为82%。总体死亡率为1.3%；并发症发生率为24%（Clavien-Dindo≥III级占10%）。平均住院时间为7天（中位数5天；范围2 - 46天）。RLR是腹腔镜手术的一种安全有效的替代方法，围手术期结果相当或更优。中等规模的中心可以通过RLR取得高质量的结果。持续的技术进步将进一步扩大其在越来越复杂的肝脏手术中的应用。
