The effect of the robotic platform in hepatectomy after prior liver and non-liver abdominal operations: a comparative study of clinical outcomes

Sucandy, Iswanto; Shapera, Emanuel; Crespo, Kaitlyn; Syblis, Cameron; Przetocki, Valerie; Ross, Sharona; Rosemurgy, Alexander S.

doi:10.1007/s11701-021-01343-z

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…They expose the patients to a different level of stress, i.e., from an anesthesiological point of view, causing further morbidity [ 6 , 33 , 34 ]. Overall, procedure times reported herein were comparable to the times reported by other studies [ 24 , 32 , 35 ]. Interestingly, procedure times for ICG-supported RALS were significantly shorter.…”

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

“…RALS has been proven to be safe and non-inferior in comparison to open and laparoscopic surgery, including both minor and major hepatectomies [ 1 , 2 , 3 , 26 , 28 , 30 , 31 , 32 ]. However, long procedure times are often considered a drawback of robotic surgery [ 1 , 2 , 3 , 26 , 28 , 30 , 31 , 32 ]. They expose the patients to a different level of stress, i.e., from an anesthesiological point of view, causing further morbidity [ 6 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

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The Role of ICG in Robot-Assisted Liver Resections

Mehdorn

Richter

Heß

et al. 2022

JCM

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Introduction: Robotic-assisted liver surgery (RALS) with its known limitations is gaining more importance. The fluorescent dye, indocyanine green (ICG), is a way to overcome some of these limitations. It accumulates in or around hepatic masses. The integrated near-infrared cameras help to visualize this accumulation. We aimed to compare the influence of ICG staining on the surgical and oncological outcomes in patients undergoing RALS. Material and Methods: Patients who underwent RALS between 2014 and 2021 at the Department of General Surgery at the University Hospital Schleswig-Holstein, Campus Kiel, were included. In 2019, ICG-supported RALS was introduced. Results: Fifty-four patients were included, with twenty-eight patients (50.9%) receiving preoperative ICG. Hepatocellular carcinoma (32.1%) was the main entity resected, followed by the metastasis of colorectal cancers (17%) and focal nodular hyperplasia (15.1%). ICG staining worked for different tumor entities, but diffuse staining was noted in patients with liver cirrhosis. However, ICG-supported RALS lasted shorter (142.7 ± 61.8 min vs. 246.4 ± 98.6 min, p < 0.001), tumors resected in the ICG cohort were significantly smaller (27.1 ± 25.0 mm vs. 47.6 ± 35.2 mm, p = 0.021) and more R0 resections were achieved by ICG-supported RALS (96.3% vs. 80.8%, p = 0.075). Conclusions: ICG-supported RALS achieve surgically and oncologically safe results, while overcoming the limitations of RALS.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Role of ICG in Robot-Assisted Liver Resections

Mehdorn

Richter

Heß

et al. 2022

JCM

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“…The operating surgeon does not have criteria for choosing which patient undergoes laparoscopic or robotic cholecystectomy but utilizes the platform as its availability, the needs of the patient, and the schedule permits. A history of prior abdominal operations did not constitute a major contraindication to the robotic platform, and it has recently been shown to be safe to proceed with a robotic approach in these situations [ 7 ]. An Institutional Review Board waiver was granted due to the retrospective nature of the study.…”

Section: Methodsmentioning

confidence: 99%

Robotic Cholecystectomy Remains Safe and Effective After Regular Staffing Hours

Shapera,

Touadi,

Dickow

et al. 2024

Cureus

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Background Robotic-assisted surgery continues to grow in popularity. Access during evenings and weekends for non-elective operations can be restricted out of safety concerns. We sought to analyze and compare outcomes of patients undergoing robotic cholecystectomy, a common urgent procedure for acute calculous cholecystitis, during regular hours versus evenings or weekends. Based on this comparison, we sought to determine if this restriction is justified. Methods We performed a retrospective analysis of 46 patients who underwent robotic cholecystectomy for acute calculous cholecystitis per 2018 Tokyo criteria by a single surgeon at a single institution between 2021 and 2022. Patients were grouped as undergoing “after-hours” cholecystectomy if the operation started at five pm or later, or anytime during the weekend (Saturday, Sunday). Demographic, perioperative, and outcome variables were tabulated and analyzed. For illustrative purposes, the data presented as median ± standard deviation were applicable. Results After-hours cholecystectomy occurred in 26 patients and regular-hours cholecystectomy occurred in 20 patients. There were no significant differences in perioperative variables between the two cohorts in terms of body mass index, age, gender, cirrhotic status, American Society of Anesthesiology score, white blood cell count, or neutrophil percentage. The after-hours group had more prior abdominal operations. There were no significant differences between the two groups in terms of operative time, estimated blood loss, or length of stay. There were no mortalities. There was one readmission in the after-hours cohort unrelated to the operation. Conclusion Robotic cholecystectomy can be safely performed on the weekends and evenings. Hospitals should make the robotic platform available during this time.

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“…A history of prior abdominal operations or even a prior hepatectomy does not constitute a major contraindication and it has recently been shown to be safe to proceed with a robotic approach in this setting. 7…”

Section: Data Source and Inclusion Criteriamentioning

confidence: 99%

Analysis of Oncological Outcomes After Robotic Liver Resection for Intrahepatic Cholangiocarcinoma

Shapera

Ross

Syblis

et al. 2022

The American Surgeon™

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Background Concerns regarding minimally invasive liver resection of intrahepatic cholangiocarcinoma (IHCC) include inadequate resection margins and inferior long-term overall survival (OS) when compared to an “open” approach. Limited data exists to address these issues. We aimed to compare perioperative variables, tumor distance to margin, and long-term outcomes after IHCC resection based on surgical approach (robotic vs open) in our hepatobiliary center to address these concerns. Methods With IRB approval, 34 patients who underwent robotic or open hepatectomy for IHCC were prospectively followed. Patients were stratified by tumor distance to resection margin (≤1 mm, 1.1-9.9 mm, ≥10 mm) for illustrative purposes and by approach (robotic vs open). Where appropriate, regression analysis and cox model of proportional hazards were utilized. Survival was stratified by margin distance and approach utilizing Kaplan-Meier curves. Data are presented as median (mean ± SD). Results Patients undergoing robotic vs open hepatectomy had similar demographics. Patients undergoing the robotic approach had significantly lower estimated blood loss (EBL). Tumor distance to margin between the two approaches were similar ( P = .428). Median OS between the two approaches was similar in patients of any margin distance. In the subgroup analysis by margin distance, the robotic approach yielded less EBL for patients in the 1.1-9.9 mm and ≥10 mm margin groups, and a shorter ICU length of stay for patients with ≥10 mm margin. Discussion Similar margins were attained via either approach, translating into oncological non-inferiority of robotic IHCC resection. Robotic approach for the treatment of IHCC should be considered an alternative to an open approach.

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The effect of the robotic platform in hepatectomy after prior liver and non-liver abdominal operations: a comparative study of clinical outcomes

Cited by 6 publications

References 15 publications

The Role of ICG in Robot-Assisted Liver Resections

The Role of ICG in Robot-Assisted Liver Resections

Robotic Cholecystectomy Remains Safe and Effective After Regular Staffing Hours

Analysis of Oncological Outcomes After Robotic Liver Resection for Intrahepatic Cholangiocarcinoma

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