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Lee M, Chae YS, Park S, Yun WG, Jung HS, Han Y, Kwon W, Park JS, Jang JY. Current trends in types of pancreatoduodenectomy: Focus on the advancement of robot-assisted pancreatoduodenectomy with 630 consecutive cases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2024. [PMID: 39555959 DOI: 10.1002/jhbp.12086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2024]
Abstract
BACKGROUND Pancreatoduodenectomy (PD) is a complex abdominal surgery, and the adoption of robotic PD has been on the rise because of its numerous benefits. This study aimed to investigate the current PD trends, focusing on advancements in robotic surgery. METHODS Between 2015 and 2023, 1231 patients underwent open PD, whereas 630 underwent robot-assisted PD (RAPD). Demographics and surgical outcomes were analyzed according to the time period. Moreover, a propensity score-matched (PSM) analysis was performed to evaluate the clinical outcomes. RESULTS The proportion of RAPD cases gradually increased from 6.3% in 2015 to 50.9% in 2020, reaching a plateau of >50% thereafter. The proportion of patients receiving neoadjuvant chemotherapy increased during the late period (11.4% vs. 17.6%), with many of these patients undergoing open PD. Additionally, RAPD was performed in patients with a high probability of postoperative pancreatic fistula. However, the two groups demonstrated no significant difference in the occurrence of clinically relevant postoperative pancreatic fistula (10.6% vs. 9.5%, p = .532). Among periampullary cancer cases, RAPD demonstrated comparable survival outcomes to open PD after PSM (5-year survival rate: 61.8% vs. 49.8%, p = .189). CONCLUSIONS RAPD has become a stable approach, accounting for over 50% of all PD cases in high-volume centers, and it can be safely performed. However, open PD remains important owing to the development of neoadjuvant therapy and the aging population. Therefore, establishing appropriate indications to maximize the benefits of both RAPD and open PD is necessary.
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Affiliation(s)
- Mirang Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Hepatobiliary and Pancreatic Surgery, Asan Medical Center, Seoul, Republic of Korea
| | - Yoon Soo Chae
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seulah Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Won-Gun Yun
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye-Sol Jung
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Seong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Hill AL, Scherer MD, Kiani A, Vachharajani N, Matson S, Cullinan DR, Martens GR, Yu J, Davidson JT, Wellen JR, Chapman WC, Doyle MB, Khan AS. The impact of a dedicated operating room team on robotic transplant program growth and fellowship training. Clin Transplant 2023; 37:e15103. [PMID: 37605386 DOI: 10.1111/ctr.15103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Despite considerable interest in robotic surgery, successful incorporation of robotics into transplant programs has been challenging. Lack of a dedicated OR team with expertise in both robotics and transplant is felt to be a major barrier. This paper assesses the impact of a dedicated robotic transplant team (DART) on program growth and fellowship training at one of the largest robotic transplant programs in North America. METHODS This is a single center, retrospective review of all robotic operations performed on the transplant surgery service from October 2017 to October 2022. DART was incorporated in February 2020 and included transplant first assists (RFAs), scrub technologists and circulating nurses who received robotic training. Robotic experience before and after DART was compared to assess its impact on program growth and training. RESULTS Four hundred and two robotic cases were performed by five transplant surgeons: 63 pre-DART and 339 post-DART. 40% of cases were transplant-related and 59.5%, HPB. There was a significant increase in case volume (2.5-10.6 cases/month, p < .0001) and complexity (36.5% vs. 70.3% high complexity cases, p < .0001) post-DART. RFA case coverage increased from 17% to 95%, and participation of transplant fellows as primary surgeons increased from 17% to 95% post-DART period (both p < .05). Conversion rates (9.5% vs. 4.1%) and room turn-around-times (TAT) (58.4 vs. 40.3 min) were lower post-DART (p < .05). There were no emergent conversions, conversions in transplant patients, or robot-related complications in either group. CONCLUSION OR teams with expertise in robotics and transplant surgery can accelerate growth of robotic transplant programs while maintaining patient safety.
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Affiliation(s)
- Angela L Hill
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Meranda D Scherer
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amen Kiani
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Neeta Vachharajani
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sarah Matson
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Darren R Cullinan
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Greg R Martens
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jennifer Yu
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jesse T Davidson
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jason R Wellen
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - William C Chapman
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Majella B Doyle
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Adeel S Khan
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Rammohan A, Rela M. Robotic donor hepatectomy: Are we there yet? World J Gastrointest Surg 2021; 13:668-677. [PMID: 34354800 PMCID: PMC8316848 DOI: 10.4240/wjgs.v13.i7.668] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/09/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
In living donor liver transplantation (LDLT) the safety of the live donor (LD) is of paramount importance. Despite all efforts, the morbidity rates approach 25%-40% with conventional open donor hepatectomy (DH) operations. However, most of these complications are related to the operative wound and despite increased self- esteem and satisfaction in various quality of life analyses on LD, the most common grievance is that of the scar. Performing safe and precise DH through a conventional laparoscopic approach is a formidable task with a precipitous learning curve for the whole team. Due to the ramifications the donor operation carries for the donor, the recipient, the transplant team and for the LDLT program in general, the development and acceptance of minimally invasive DH (MIDH) has been slow. The robotic surgical system overcomes the reduced visualization, restricted range of motion and physiological tremor associated with laparoscopic surgery and allows for a comparatively easier transition from technical feasibility to reproducibility. However, many questions especially with regards to standardization of surgical technique, comparison of outcomes, understanding of the learning curve, etc. remain unanswered. The aim of this review is to provide insights into the evolution of MIDH and highlight the current status of robotic DH, appreciating the existing challenges and its future role.
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Affiliation(s)
- Ashwin Rammohan
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
| | - Mohamed Rela
- Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai 600044, India
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Lee H, Lee J, Lee K, Kim JY, Park HS. Comparison between Gasless and Gas-Inflated Robot-Assisted Nipple-Sparing Mastectomy. J Breast Cancer 2021; 24:183-195. [PMID: 33913274 PMCID: PMC8090802 DOI: 10.4048/jbc.2021.24.e20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/15/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose Nipple-sparing mastectomy (NSM) includes various techniques, including conventional or endoscopic mastectomies. Since the introduction of robot-assisted NSM (RANSM) in 2015, 2 main methods have been used: gasless and gas-inflated techniques. The aim of this study was to compare clinicopathologic characteristics, surgical outcomes, and postoperative complications between patients treated with gasless RANSM and those treated with gas-inflated RANSM. Methods We conducted a retrospective study of women who underwent gasless or gas-inflated RANSM with immediate breast reconstruction between November 2016 and May 2019. The indications for RANSM were early breast cancer, interstitial mastopathy, or BRCA1/2 mutation carriers. Clinicopathologic characteristics, surgical outcomes, and postoperative complications were analyzed. The severity of complications was graded using the Clavien-Dindo system. Results A total of 58 RANSM procedures were performed in 46 women: 15 cases of gasless RANSM and 43 cases of gas-inflated RANSM. The proportion of node-negative disease was higher in the gas-inflated group (97.1%) than in the gasless group (69.2%, p = 0.016). Adjuvant radiotherapy was administered in 30.6% of the cases in the gasless group and only 5% of the cases in the gas-inflated group. Other clinicopathological factors were not significantly different between the groups. Regarding surgical outcomes, the initial incision was 1 cm longer in the gasless group (5.17 ± 0.88 cm) than that in the gas-inflated group (4.20 ± 1.05 cm; p = 0.002). The final incision was also longer in the gasless group (5.17 ± 0.88 cm) than that in the gas-inflated group (4.57 ± 1.07 cm; p = 0.040). Operation time, complication rate, and complication grade were not significantly different between the 2 groups. Conclusion In this study, there were no significant differences in surgical outcomes or postoperative complications between gasless and gas-inflated RANSM, except for a longer incision with the gasless technique. Both techniques are reasonable options for RANSM followed by immediate reconstruction.
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Affiliation(s)
- Haemin Lee
- Division of Breast Surgery, Department of Surgery, Breast Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeea Lee
- Division of Breast Surgery, Department of Surgery, Breast Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kwanbum Lee
- Division of Breast Surgery, Department of Surgery, Breast Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Ye Kim
- Division of Breast Surgery, Department of Surgery, Breast Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Seok Park
- Division of Breast Surgery, Department of Surgery, Breast Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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Marino MV, Podda M, Gomez Ruiz M, Fernandez CC, Guarrasi D, Gomez Fleitas M. Robotic-assisted versus open pancreaticoduodenectomy: the results of a case-matched comparison. J Robot Surg 2019; 14:493-502. [PMID: 31473878 DOI: 10.1007/s11701-019-01018-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023]
Abstract
Robotic-assisted pancreaticoduodenectomy (RPD) is progressively gaining momentum. It seems to provide some potential advantages over open approach. Unfortunately, only few studies investigated the impact of RPD on the oncologic outcomes. We performed a 1:1 case-matched comparison between two groups of 35 patients affected by a malignant tumor who underwent RPD and open (OPD) pancreaticoduodenectomy from August 2014 to April 2016. Operative time was longer in the RPD group compared to OPD (355 vs 262 min, p = 0.023), whereas median blood loss (235 vs 575 ml, p = 0.016) and length of hospitalization (6.5 vs 8.9 days, p = 0.041) were lower for RPD. A significant reduction of overall postoperative morbidity rate was found in the RPD group compared to the OPD group (31.4% vs 48.6% p = 0.034). No statistically significant difference was found between the two groups in terms of overall pancreatic fistula rate, R0 resection rate, and number of harvested lymph nodes. The overall and disease-free survival at 1 and 3 years were similar. RPD is a safe and effective technique. It reduces the estimated blood loss, the length hospital of stay and the rate of complications after pancreaticoduodenectomy, while preserving a good oncologic adequacy.
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Affiliation(s)
- Marco Vito Marino
- Department of Surgery, Palermo University, Palermo, Italy.
- Department of General and Digestive Surgery, Hospital Universitario Marquès de Valdecilla, Av. De Valdecilla 25, Santander, Cantabria, Spain.
| | - Mauro Podda
- Department of General, Emergency and Minimally Invasive Surgery, Cagliari University Hospital "Policlinico D. Casula", Cagliari, Italy
| | - Marcos Gomez Ruiz
- Department of General and Digestive Surgery, Hospital Universitario Marquès de Valdecilla, Av. De Valdecilla 25, Santander, Cantabria, Spain
| | - Carmen Cagigas Fernandez
- Department of General and Digestive Surgery, Hospital Universitario Marquès de Valdecilla, Av. De Valdecilla 25, Santander, Cantabria, Spain
| | - Domenico Guarrasi
- Department of Emergency Surgery, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Manuel Gomez Fleitas
- Department of General and Digestive Surgery, Hospital Universitario Marquès de Valdecilla, Av. De Valdecilla 25, Santander, Cantabria, Spain
- Department of Surgical Innovation and Robotic Surgery, Hospital Universitario Marquès de Valdecilla, Santander, Spain
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Aceto P, Beretta L, Cariello C, Claroni C, Esposito C, Forastiere EM, Guarracino F, Perucca R, Romagnoli S, Sollazzi L, Cela V, Ercoli A, Scambia G, Vizza E, Ludovico GM, Sacco E, Vespasiani G, Scudeller L, Corcione A. Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU. Minerva Anestesiol 2019; 85:871-885. [PMID: 30938121 DOI: 10.23736/s0375-9393.19.13360-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Proper management of patients undergoing robotic-assisted urologic and gynecologic surgery must consider a series of peculiarities in the procedures for anesthesiology, critical care medicine, respiratory care, and pain management. Although the indications for robotic-assisted urogynecologic surgeries have increased in recent years, specific guidance documents are still lacking. EVIDENCE ACQUISITION A multidisciplinary group including anesthesiologists, gynecologists, urologists, and a clinical epidemiologist systematically reviewed the relevant literature and provided a set of recommendations and unmet needs on peculiar aspects of anesthesia in this field. EVIDENCE SYNTHESIS Nine core contents were identified, according to their requirements in urogynecologic robotic-assisted surgery: patient position, pneumoperitoneum and ventilation strategies, hemodynamic variations and fluid therapy, neuromuscular block, renal surgery and prevention of acute kidney injury, monitoring the Department of anesthesia, postoperative delirium and cognitive dysfunction, prevention of postoperative nausea and vomiting, and pain management in endometriosis. CONCLUSIONS This consensus document provides guidance for the management of urologic and gynecologic patients scheduled for robotic-assisted surgery. Moreover, the identified unmet needs highlight the requirement for further prospective randomized studies.
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Affiliation(s)
- Paola Aceto
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Luigi Beretta
- Unit of Anesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Cariello
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy
| | - Claudia Claroni
- Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Clelia Esposito
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Ester M Forastiere
- Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy
| | - Raffaella Perucca
- Department of Anesthesia and Intensive Care, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Romagnoli
- Section of Anesthesia and Critical Care, Health Science Department, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, Careggi Hospital, Florence, Italy
| | - Liliana Sollazzi
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Vito Cela
- Department of Clinical and Experimental Medicine, Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, Amedeo Avogadro University of Eastern Piedmont, Maggiore Hospital, Novara, Italy
| | - Giovanni Scambia
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Enrico Vizza
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe M Ludovico
- Department of Urology, F. Miulli Regional Hospital, Acquavivadelle Fonti, Bari, Italy
| | - Emilio Sacco
- Department of Urology, Sacred Heart Catholic University, A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy
| | - Giuseppe Vespasiani
- Department of Experimental Medicine and Surgery, University Hospital of Tor Vergata, Rome, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, San Matteo IRCSS Foundation, Pavia, Italy -
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
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Liu R, Wakabayashi G, Kim HJ, Choi GH, Yiengpruksawan A, Fong Y, He J, Boggi U, Troisi RI, Efanov M, Azoulay D, Panaro F, Pessaux P, Wang XY, Zhu JY, Zhang SG, Sun CD, Wu Z, Tao KS, Yang KH, Fan J, Chen XP. International consensus statement on robotic hepatectomy surgery in 2018. World J Gastroenterol 2019; 25:1432-1444. [PMID: 30948907 PMCID: PMC6441912 DOI: 10.3748/wjg.v25.i12.1432] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
The robotic surgical system has been applied in liver surgery. However, controversies concerns exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts’ consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication, techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.
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Affiliation(s)
- Rong Liu
- Second Department of Hepatopancreatobiliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing 100853, China
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo 362-8588, Japan
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Hospital, Daegu 705-703, South Korea
| | - Gi-Hong Choi
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, South Korea
| | - Anusak Yiengpruksawan
- Minimally Invasive Surgery Division, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Yuman Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Jin He
- Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States
| | - Ugo Boggi
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa 56124, Italy
| | - Roberto I Troisi
- Department of Clinical Medicine and Surgery, Federico II University, Naples 80131, Italy
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow 11123, Russia
| | - Daniel Azoulay
- Hepato-Biliary Center, Paul Brousse University Hospital, Villejuif 94000, France
- Hepato-Biliary Center, Tel Hashomer University Hospital, Tel Aviv, Israel
| | - Fabrizio Panaro
- Department of Surgery/Division of HBP Surgery and Transplantation, Montpellier University Hospital—School of Medicine, Montpellier 34000, France
| | - Patrick Pessaux
- Head of the Hepato-biliary and pancreatic surgical unit, Nouvel Hôpital Civil, Strasbourg Cedex 67091, France
| | - Xiao-Ying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ji-Ye Zhu
- Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing 100044, China
| | - Shao-Geng Zhang
- Department of Hepatobiliary Surgery, 302 Hospital of Chinese PLA, Beijing 100039, China
| | - Chuan-Dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, Shandong Province, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Kai-Shan Tao
- Department of Hepatobiliary Surgery, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
| | - Ke-Hu Yang
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Guerra F, Di Marino M, Coratti A. Robotic Surgery of the Liver and Biliary Tract. J Laparoendosc Adv Surg Tech A 2019; 29:141-146. [PMID: 30118390 DOI: 10.1089/lap.2017.0628] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The laparoscopic methods for major abdominal surgery are gaining increasing acceptance worldwide. Despite its relatively recent introduction in clinical practice, robotics has been accepted as an effective option to perform high-demanding procedures such as those required in hepatobiliary surgery. Some potential advantages over conventional laparoscopy have been suggested, but its actual role in clinical practice is still to be defined. METHODS The objective of this work is to critically review the available evidence on the application of robotic surgery to the liver and biliary tract. PubMed, Embase, and the Cochrane Library electronic databases were systematically searched for studies reporting on robotic hepatobiliary surgery with or without comparison with open surgery or conventional laparoscopy. RESULTS This review provides a comprehensive snapshot of the current application of the robot to the surgery of the liver and biliary tract. The overall available data show the noninferiority of the robotic system to conventional open and laparoscopic surgery. A number of studies suggest some potential advantages in performing high-demanding procedures in a minimally invasive fashion. CONCLUSIONS The robot can be used to perform various types of liver surgeries quite safely and competently, although the lack of randomized control trials, comparing it with open and laparoscopic surgery, precludes the possibility to reach definitive conclusions.
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Affiliation(s)
- Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence, Italy
| | - Michele Di Marino
- Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence, Italy
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence, Italy
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9
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Cortolillo N, Patel C, Parreco J, Kaza S, Castillo A. Nationwide outcomes and costs of laparoscopic and robotic vs. open hepatectomy. J Robot Surg 2018; 13:557-565. [PMID: 30484059 DOI: 10.1007/s11701-018-0896-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/20/2018] [Indexed: 12/16/2022]
Abstract
The safety of hepatectomy continues to improve and it holds a key role in the management of benign and malignant hepatic lesions. Laparoscopic and robotic approaches to hepatectomy are increasingly utilized. The purpose of this study was to compare outcomes and costs of laparoscopic and robotic vs. open approaches to hepatectomy and to determine the national nonelective postoperative readmission rate, including readmission to other hospitals. The Nationwide Readmission Database from 2013 to 2014 was queried for all patients undergoing hepatectomy. Patients undergoing laparoscopic and robotic hepatectomies were compared to patients undergoing open hepatectomy. Multivariate logistic regression was implemented to determine the odds ratios (OR) for non-elective readmission within 45 days. There were 10,870 patients who underwent hepatectomy from 2013 to 2014 and 724 (6.7%) were approached with laparoscopic or robotic technique. The robotic cohort had lower mean cost of the index admission ($24,983 ± $18,329 vs. open $32,391 ± $31,983, p < 0.001, 95% CI - 18,292 to 534), shorter LOS (4.5 ± 3.8 vs. lap 6.8 ± 6.0 vs. open 7.6 ± 7.7 days, p < 0.01), and were less likely to be readmitted within 45 days (7.9% vs. 13.0% lap vs. 13.8% open, p = 0.05). The robotic cohort was slightly younger (mean age 57.5 ± 13.5 vs. lap 60.1 ± 13.8 vs. open 58.9 ± 13.7, p < 0.05), and no significant differences were seen by Charlson Comorbidity Index. Anastomosis of hepatic duct to GI tract carried higher odds of mortality (OR 2.87, p < 0.01) and higher odds of readmission (OR 1.40, p < 0.01). LOS above 7 days increased odds of readmission (OR 2.24, p < 0.01). Nearly one-fifth of patients readmitted after hepatectomy present to a different hospital. Robotic hepatectomy was associated with favorable cost and readmission outcomes compared to laparoscopic and open hepatectomy patients, despite similar patient comorbid burdens and patient's age. Length of stay over 7 days and anastomosis of hepatic duct to GI tract are strong risk factors for readmission and mortality.
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Affiliation(s)
- Nicholas Cortolillo
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA.
| | - Chetan Patel
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA
| | - Joshua Parreco
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA
| | - Srinivas Kaza
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA
| | - Alvaro Castillo
- Department of Surgery, University of Miami Miller School of Medicine, 5301 S. Congress Av, Atlantis, FL, 33462, USA
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Affiliation(s)
- Fabrizio Panaro
- Division of Transplantation, Department of Surgery, Montpellier University Hospital-School of Medicine, Montpellier, France
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
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Stiegler P, Schemmer P. Robot-Assisted Transplant Surgery - Vision or Reality? A Comprehensive Review. Visc Med 2018; 34:24-30. [PMID: 29594166 PMCID: PMC5869533 DOI: 10.1159/000485686] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Minimally invasive surgery is standard procedure for many operations. Further refinements include the introduction of robotic surgery which is still an emerging field especially in laparoscopic surgery. Since the successful introduction of the da Vinci Robotic Surgical System, the robotic approach in organ transplantation has become of great interest in both the live donor organ retrieval and the recipient operation. Robotic surgery for kidney, liver, and pancreas transplantation is feasible. Over 700 donor nephrectomies and 100 kidney transplantations have been performed already, and robotic surgery is standard in a small number of pioneer centers; however, larger series and most importantly randomized controlled trials for the highest evidence are needed. Longer warm ischemia time and higher costs limit these procedures at the moment.
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Affiliation(s)
- Philipp Stiegler
- Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Transplant Center Graz, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Transplant Center Graz, Medical University of Graz, Graz, Austria
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12
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Robotic-Assisted Live Donor Ileal Segmentectomy for Intestinal Transplantation. Transplant Direct 2017; 3:e215. [PMID: 29026878 PMCID: PMC5627746 DOI: 10.1097/txd.0000000000000719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/16/2017] [Indexed: 12/11/2022] Open
Abstract
Background Every effort should be made to optimize surgical techniques and to minimize potential morbidity rates associated with live donor operations. Advances in a minimally invasive approach by robotic surgery to donor nephrectomy have raised the possibility of applying this technique to live donor bowel resections for intestinal transplantation. Methods We report the first 5 consecutive cases of a robotic-assisted live donor ileal segmentectomy. We describe the technical aspects of the procedure, discuss the rationale for considering this option, and evaluate potential advantages of this approach. Results We found that this new approach is associated with less postoperative discomfort, a shorter hospital length of stay, and a faster recovery of bowel function compared to our previous open surgery. Conclusions Our initial experience suggests that robotic surgery is a safe and feasible procedure for live donor ileal resection for intestinal transplantation and is a useful alternative to conventional open surgery.
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Sengupta B, Serrano OK, Sutherland DER, Kandaswamy R. Living Donor Pancreas Transplants: Donor Selection and Risk Minimization. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Magistri P, Tarantino G, Ballarin R, Coratti A, Di Benedetto F. Robotic liver donor right hepatectomy: A pure, minimally invasive approach. Liver Transpl 2017; 23:857-858. [PMID: 28407413 DOI: 10.1002/lt.24767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/29/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy.,Department of Medical and Surgical Sciences and Translational Medicine Faculty of Medicine and Psychology, Sapienza-University of Rome, Rome, Italy
| | - Giuseppe Tarantino
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Coratti
- Division of Surgical Oncology and Robotics, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
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