Robotic Hepatectomy Is a Safe and Cost-Effective Alternative to Conventional Open Hepatectomy: a Single-Center Prelimina
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RESEARCH COMMUNICATION
Robotic Hepatectomy Is a Safe and Cost-Effective Alternative to Conventional Open Hepatectomy: a Single-Center Preliminary Experience Jason Hawksworth 1,2 & Nathaly Llore 3 & Matthew L. Holzner 3 & Pejman Radkani 1 & Erin Meslar 1 & Emily Winslow 1 & Rohit Satoskar 1 & Ruth He 4 & Reena Jha 5 & Nadim Haddad 6 & Thomas Fishbein 1 Received: 24 April 2020 / Accepted: 6 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Keywords Robotic surgery . Hepatectomy . da Vinci . Hepatobiliary surgery . Minimally invasive surgery
Introduction The majority of liver surgery worldwide continues to be performed open, as laparoscopic hepatectomy is technically chal1 lenging with a steep learning curve. Robotic technology overcomes many of the technical limitations of laparoscopy and improves the ability of hepatobiliary surgeons to safely perform minimally invasive hepatectomy, particularly major 2–4 hepatectomy. However, robotic hepatectomy has not been widely applied worldwide and is limited to centers with extensive experience in minimally invasive hepatobiliary surgery. The objective of this study was to determine the safety profile and cost-effectiveness of robotic hepatectomy when compared with traditional open hepatectomy.
Methods This was an IRB-approved, retrospective review of a prospectively maintained database of all hepatectomies performed at a single center from September 2018 to December 2019. All patients had at least a 3-month follow-up. The only exclusion criterion at our institution for robotic hepatectomy includes the need for vascular
* Jason Hawksworth [email protected] 1
2
MedStar Georgetown Transplant Institute, 2 PHC, MedStar Georgetown University Hospital, 3800 Reservoir Rd. NW, Washington, DC 20007, USA Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
reconstruction or associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Robotic hepatectomies were performed by two hepatobiliary trained surgeons (JH, PR) with additional credentials in robotic surgery and a cumulative experience of 12 years of open hepatobiliary surgery. The da Vinci Si® robotic platform was used for the robotic liver cases. Robotic ports were placed across the upper abdomen with an assist port placed in the umbilicus. Specimen extraction was performed through a Pfannenstiel incision or by extending the umbilical port. Both open and robotic hepatectomies were approached with similar technique utilizing extrahepatic inflow control whenever possible and the cavitron ultrasonic surgical aspiratory (CUSA) device (Integra Lifesciences, Plainsboro, NJ, USA) was used to divide the parenchyma. During parenchymal transection, biliary and vascular structures were controlled with ties and clips in both open and robotic cases. In the robotic cases, the vessel sealer was also used during parenchymal transection. Cost Analysis The operative cost analysis was calculated by totaling the cost of case disposables for open
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