Robotic hepatic resection in postero-superior region of liver
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ORIGINAL ARTICLE
Robotic hepatic resection in postero‑superior region of liver Zhiming Zhao1 · Zhuzeng Yin1 · Lichao Pan1 · Chenggang Li1 · Minggen Hu1 · Wan Yee Lau2 · Rong Liu1 Received: 7 April 2020 / Accepted: 29 September 2020 © Italian Society of Surgery (SIC) 2020
Abstract Objective Laparoscopic hepatectomy in the posterosuperior hepatic region is technically challenging and demanding. However, minimally invasive procedures carried out using the Da Vinci robot provide potential advantages in complex hepatectomy. This study reported the experience of a single center on robotic hepatectomy in the posterosuperior hepatic region. Methods This retrospective study evaluated the general characteristics and perioperative outcomes of consecutive patients who underwent robotic hepatectomy in the posterosuperior hepatic region at our center from March 2015 to January 2020. Results For 100 patients who were included into this study, 53 underwent anatomical segmentectomy or subsegmentectomy and 47 non-anatomical partial hepatectomy. There was no conversion to laparotomy. The R0 resection rate was 100%. The following perioperative outcomes were compared between patients who underwent anatomical segmentectomy/subsegmentectomy versus those who underwent non-anatomical partial hepatectomy: operation times of 160 versus 126 min, intraoperative blood losses of 100 versus 50 ml, intraoperative blood transfusion rates of 7.54% versus 4.26%, postoperative lengths of hospital stay of 5 versus 4 days, Clavien–Dindo Grade I–II complications rates of 15.09% versus 19.15%, Grade III–V complications rates of 3.77% versus 0%, bile leakage rates of 4% versus 7% and pleural effusion rates of also 4% versus 7%, respectively. Conclusion The results indicated the safety and feasibility of robotic anatomical and non-anatomical liver resections in the posterosuperior hepatic region. The robotic transabdominal approach is an option for hepatectomy in the posterosuperior hepatic region. Keywords Hepatectomy · Robotic surgery · Posterosuperior segments · Segmentectomy · Subsegmentectomy
Introduction The posterosuperior region of the liver is located in the deep and difficult-to-expose region near the diaphragm. This region is closely related to hepatic veins and inferior vena cava and mainly includes Couinaud liver segments I, IVa, VII, and VIII. Laparoscopic hepatectomy in this region is Zhiming Zhao and Zhuzeng Yin contributed equally to this work, and should be considered as first authors. * Wan Yee Lau [email protected] * Rong Liu [email protected] 1
The Second Department of Hepatopancreatobiliary Surgery, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
2
considered technically difficult because of the challenges associated with exposing the surgical field of view and controlling intraoperative blood loss, thus leading to a long learning curve as a consequence as imposed by
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