Robotic major and minor hepatectomy: critical appraisal of learning curve and its impact on outcomes

Ahmad, Ali; Freeman, Hadley D.; Corn, Sarah

doi:10.1007/s00464-022-09809-3

Cited by 9 publications

(2 citation statements)

References 25 publications

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“…The authors believe the mean operative time of 86 min and mean console time of 58 min are not inferior to our own experience with open non-anatomical liver resections. Direct comparison with published literature is difficult as most series report an average operating time for combined minor and major robotic liver resections of approximately 4 h [23][24][25]. Our series represented very well a range of hepatic tumours normally requiring minor liver resection, and the result confirmed that this could be achieved safely via robotic approach with satisfactory oncological outcomes for cancer cases judged by the R0 status and minimal blood loss as evidenced by a stable post-operative haemoglobin level.…”

Section: Discussionsupporting

confidence: 52%

Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre

Yeung,

Vellaisamy,

Hussain

et al. 2024

Surg Endosc

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Background Liver surgery is associated with a significant hospital stay regardless the type of liver resection. A large incision is essential for open liver surgery which is a major factor in the course of the patient’s recovery. For patients with small parenchyma liver lesions requiring surgical resection, robotic surgery potentially offers the opportunity to transform the patient’s post-operative course. A day-case robotic liver resection pathway was formulated and implemented at our institution when patients were planned for discharge within 24 h of admission for liver surgery. Methods Single surgeon case series of cases performed at a tertiary hepatobiliary and pancreatic centre between September 2022 and November 2023. The inclusion criteria were non-anatomical wedge resections, < 2 anatomical segmental resections, left lateral hepatectomy and minimally invasive surgery. Results This is the first series of robotic day-case minor liver resection in the United Kingdom. 20 patients were included in this case series. The mean operative time was 86.6 ± 30.9 min and mean console time was 58.6 ± 24.5 min. Thirteen patients (65%) were discharged within 24 h of surgery. The main cause of hospitalisation beyond 24 h was inadequate pain relief. There were no Clavien–Dindo grade III or above complications, no 30-day readmission and 90-day mortalities. Conclusion This case series demonstrates that robotic day-case liver resection is safe and feasible. Robust follow-up pathways must be in place to allow for the safe implementation of this approach, to monitor for any complications and to allow intervention as required in a timely manner.

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Section: Discussionsupporting

confidence: 52%

Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre

Yeung,

Vellaisamy,

Hussain

et al. 2024

Surg Endosc

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“…In a large Italian registry study, open and laparoscopic ALPPS were compared and the minimally invasive approach decreased the overall complication rate after stage 1, lowered the PHLF rate, and was even associated with a reduced in-hospital mortality rate in multivariate analysis [ 20 ]. A similar or even more pronounced effect could be expected for the robotic ALPPS approach after surpassing the learning curve of around 20–60 cases for major liver resections [ 11 , 21 ]. Both centers included in this study have not implemented laparoscopic ALPPS and therefore, a direct comparison to laparoscopic ALPPS is missing.…”

Section: Discussionmentioning

confidence: 60%

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

Guidetti,

Müller,

Magistri

et al. 2024

Surg Endosc

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Background In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS. Methods The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications. Results Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56). Conclusion Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation.

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A novel low-cost high-fidelity porcine model of liver metastases for simulation training in robotic parenchyma-preserving liver resection

O’Connell,

Horne,

O’Keeffe

et al. 2024

J Robotic Surg

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Robotic major and minor hepatectomy: critical appraisal of learning curve and its impact on outcomes

Cited by 9 publications

References 25 publications

Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre

Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre

Full robotic versus open ALPPS: a bi-institutional comparison of perioperative outcomes

A novel low-cost high-fidelity porcine model of liver metastases for simulation training in robotic parenchyma-preserving liver resection

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