Robotic major hepatectomy: Is there a learning curve?

Chen, Po-Da; Wu, Chao-Yin; Hu, Rey‐Heng; Chen, Chiung-Nien; Yuan, Ray-Hwang; Liang, Jin–Tung; Lai, Hong‐Shiee; Wu, Yao‐Ming

doi:10.1016/j.surg.2016.09.025

Cited by 145 publications

(108 citation statements)

References 35 publications

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“…An interesting study showed that 15 cases (phase 1) formed the initial learning curve; 25 cases contribute to increased competency and the last 52 cases represent the matured mastery phase (phase 3) when it is possible to observe an overall improvement [37].…”

Section: Doi: 101159/000487686mentioning

confidence: 99%

Comparative Study of the Initial Experience in Performing Robotic and Laparoscopic Right Hepatectomy with Technical Description of the Robotic Technique

Marino¹,

Shabat²,

Guarrasi³

et al. 2018

Dig Surg

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Background: Despite potential benefits of robotic liver surgery, it is still considered a “development in progress” technique. Methods: The outcomes of 14 patients undergoing robotic right hepatectomy were analyzed and compared with the results of 20 laparoscopic right hepatectomies consecutively performed by the same young surgeon. Results: The overall mean operative time was less in robotic arm (425 ± 139 vs. 565.18 ± 183.73, p = 0.022) and the estimated blood loss was similar (335.15 ± 139.8 vs. 423.95 ± 205.15, p = 0.17); no blood transfusion was required. Two patients in robotic group and 5 in laparoscopic group (p = 0.454) underwent conversion to open surgery; the overall morbidity was 21.4 and 15% in studied arms, respectively (p = 0.634). Pathology reports showed a mean surgical margin of 26.02 ± 3.9 in robotic arm, 28.76 ± 4.6 for laparoscopic, (p = 0.079) and we achieved a R0 resection rate of 91.66 and 85%, respectively. Reoperation and 90-days mortality rate were both null in robotic arm. One patient in laparoscopic group was reoperated due to postoperative hemorrhage. One-year overall and disease free-survival rate were 92.3 and 84.6%, respectively in robotic arm and 90 and 85% in laparoscopic arm. Conclusions: Robotic right hepatectomy is a safe and feasible technique providing promising short-term outcomes and oncological results also in the initial phase of learning curve.

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Section: Doi: 101159/000487686mentioning

confidence: 99%

Comparative Study of the Initial Experience in Performing Robotic and Laparoscopic Right Hepatectomy with Technical Description of the Robotic Technique

Marino¹,

Shabat²,

Guarrasi³

et al. 2018

Dig Surg

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show abstract

“…Our aim is to highlight the feasibility of the procedure rather than the immediate reproducibility, keeping in mind the limitation of a single case study. Having placed patient safety as the main target of our procedures, the decision to perform ALPPS with robotic approach aimed to reduce morbidities and complications; therefore, it should be adopted only in experienced centers after having gained high proficiency with a complete learning curve . Therefore, it is the responsibility of the surgeon to know their own limits and offer the patient the best solution to achieve success.…”

Section: Discussionmentioning

confidence: 99%

“…Having placed patient safety as the main target of our procedures, the decision to perform ALPPS with robotic approach aimed to reduce morbidities and complications; therefore, it should be adopted only in experienced centers after having gained high proficiency with a complete learning curve. 29,30 Therefore, it is the responsibility of the surgeon to know their own limits and offer the patient the best solution to achieve success. ALPPS remains a difficult procedure that should be offered in experienced centers to patients requiring it for a curative treatment.…”

Section: Discussionmentioning

confidence: 99%

Full robotic ALPPS for HCC with intrahepatic portal vein thrombosis

Benedetto

Assirati

Magistri

2020

Robotics Computer Surgery

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Background The associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique can induce a greater degree of hypertrophy of the future liver remnant (FLR) in a shorter time compared with other procedures. A robotic approach may reduce the complication rate, increasing the ability to perform classic ALPPS. Methods We report technical and clinical considerations on the first full robotic ALPPS (stages 1 and 2) for hepatocellular carcinoma (HCC) with portal vein intrahepatic tumor thrombus. Results The patient was a 38‐year‐old man with Milan‐out HCC and FLR volume of 19.6%. On postoperative day (POD) 8, FLR increased to 37%; therefore, he underwent completion of ALPPS on POD 10. The postoperative course was uneventful, and the patient was discharged in good general conditions on POD 3. Conclusion Robotic ALPPS is safe and feasible for selected patients with initially unresectable HCC or requiring extended resections, with good postoperative outcomes.

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“…Systematic recent reviews by Boggi et al7 and Ho et al8 have shown that a major hepatectomy, including the right lobe, can be safely performed robotically with a low conversion rate and morbidity. Chen et al9 suggested a learning curve for major robotic hepatectomies derived from their large series, comprising of three characteristic phases: initial (phase 1, 15 patients), intermediate (phase 2, 25 patients), and mature (phase 3, 52 patients). The learning effects were underlined by shorter operation time and hospital stay after phase 1 and less blood loss after phase 2.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted right hepatectomy via anterior approach for intrahepatic cholangiocarcinoma

Goja

Singh

Chaudhary

et al. 2017

Ann Hepatobiliary Pancreat Surg

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Major hepatic resection, especially right hepatectomy, has been successfully performed by specialized hepatobiliary centers using the robotic platform with low morbidity, conversion rates and outcomes comparable to laparoscopic and open surgery. The authors report a case of robotic-assisted right hepatectomy done for intrahepatic cholangiocarcinoma using anterior approach, after right portal vein embolisation for future liver remnant volume enhancement.

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Robotic major hepatectomy: Is there a learning curve?

Cited by 145 publications

References 35 publications

Comparative Study of the Initial Experience in Performing Robotic and Laparoscopic Right Hepatectomy with Technical Description of the Robotic Technique

Comparative Study of the Initial Experience in Performing Robotic and Laparoscopic Right Hepatectomy with Technical Description of the Robotic Technique

Full robotic ALPPS for HCC with intrahepatic portal vein thrombosis

Robotic-assisted right hepatectomy via anterior approach for intrahepatic cholangiocarcinoma

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