Skip to main content
Erschienen in: World Journal of Surgery 11/2014

01.11.2014

Traditional versus Robot-Assisted Full Laparoscopic Liver Resection: A Matched-Pair Comparative Study

verfasst von: Hadrien Tranchart, Cecilia Ceribelli, Stefano Ferretti, Ibrahim Dagher, Alberto Patriti

Erschienen in: World Journal of Surgery | Ausgabe 11/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Robotic surgery was introduced as a means of overcoming the limitations of traditional laparoscopy. This report describes the results of a matched comparative study between traditional (TLLR) and robot-assisted laparoscopic liver resection (RLLR) performed in two European centers.

Methods

From January 2008–April 2013, 46 patients underwent RLLR at San Matteo degli Infermi Hospital. Each patient was matched to a patient who had undergone TLLR at Antoine Béclère Hospital. The variables evaluated were operative time, blood loss, conversion rate, morbidity, mortality, and length of hospital stay.

Results

Twenty-eight patients were included in each group. Despite matching, more tumors were solitary in the TLLR group (P = 0.02) and more were localized in the superior and posterior segments in the RLLR group (P = 0.003). The median duration of surgery was 210 and 176 min in the RLLR and TLLR groups, respectively (P = 0.12). Conversion rate, blood loss, morbidity, and length of stay were similar in both groups. In multivariate analysis in all cohorts of patients, the sole independent risk factor of postoperative complications was the operative duration [OR = 1.016; P = 0.007].

Conclusions

Robotic LLR is associated with outcomes similar to those obtained with TLLR. However, robotics may facilitate LLR in patients with superior and posterior liver tumors.
Literatur
1.
Zurück zum Zitat Cai XJ, Yang J, Yu H et al (2008) Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc 22:2350–2356PubMedCrossRef Cai XJ, Yang J, Yu H et al (2008) Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc 22:2350–2356PubMedCrossRef
2.
Zurück zum Zitat Tranchart H, Di Giuro G, Lainas P et al (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176PubMedCrossRef Tranchart H, Di Giuro G, Lainas P et al (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176PubMedCrossRef
3.
Zurück zum Zitat Laurent A, Cherqui D, Lesurtel M et al (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769PubMedCrossRef Laurent A, Cherqui D, Lesurtel M et al (2003) Laparoscopic liver resection for subcapsular hepatocellular carcinoma complicating chronic liver disease. Arch Surg 138:763–769PubMedCrossRef
4.
Zurück zum Zitat Dagher I, Di Giuro G, Dubrez J et al (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198:173–177PubMedCrossRef Dagher I, Di Giuro G, Dubrez J et al (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198:173–177PubMedCrossRef
5.
Zurück zum Zitat Belli G, Cioffi L, Fantini C et al (2009) Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results. Surg Endosc 23:1807–1811PubMedCrossRef Belli G, Cioffi L, Fantini C et al (2009) Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results. Surg Endosc 23:1807–1811PubMedCrossRef
6.
Zurück zum Zitat Laurent A, Tayar C, Andreoletti M et al (2009) Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 16:310–314PubMedCrossRef Laurent A, Tayar C, Andreoletti M et al (2009) Laparoscopic liver resection facilitates salvage liver transplantation for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 16:310–314PubMedCrossRef
7.
Zurück zum Zitat Polignano FM, Quyn AJ, de Figueiredo RS et al (2008) Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc 22:2564–2570PubMedCrossRef Polignano FM, Quyn AJ, de Figueiredo RS et al (2008) Laparoscopic versus open liver segmentectomy: prospective, case-matched, intention-to-treat analysis of clinical outcomes and cost effectiveness. Surg Endosc 22:2564–2570PubMedCrossRef
8.
9.
Zurück zum Zitat Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2,804 patients. Ann Surg 250:831–841PubMedCrossRef Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2,804 patients. Ann Surg 250:831–841PubMedCrossRef
10.
Zurück zum Zitat Dagher I, O’Rourke N, Geller DA et al (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860PubMedCrossRef Dagher I, O’Rourke N, Geller DA et al (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860PubMedCrossRef
11.
Zurück zum Zitat Gumbs AA, Bar-Zakai B, Gayet B (2008) Totally laparoscopic extended left hepatectomy. J Gastrointest Surg 12:1152PubMedCrossRef Gumbs AA, Bar-Zakai B, Gayet B (2008) Totally laparoscopic extended left hepatectomy. J Gastrointest Surg 12:1152PubMedCrossRef
12.
Zurück zum Zitat Gumbs AA, Gayet B (2008) Multimedia article. Totally laparoscopic extended right hepatectomy. Surg Endosc 22:2076–2077PubMedCrossRef Gumbs AA, Gayet B (2008) Multimedia article. Totally laparoscopic extended right hepatectomy. Surg Endosc 22:2076–2077PubMedCrossRef
13.
Zurück zum Zitat Yoon YS, Han HS, Cho JY et al (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637PubMedCrossRef Yoon YS, Han HS, Cho JY et al (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637PubMedCrossRef
14.
Zurück zum Zitat Ishizawa T, Gumbs AA, Kokudo N et al (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964PubMedCrossRef Ishizawa T, Gumbs AA, Kokudo N et al (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964PubMedCrossRef
15.
Zurück zum Zitat Yoon YS, Han HS, Cho JY et al (2013) Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery 153:502–509PubMedCrossRef Yoon YS, Han HS, Cho JY et al (2013) Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery 153:502–509PubMedCrossRef
16.
Zurück zum Zitat Tsung A, Geller DA, Sukato DC et al (2013) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259:549–555CrossRef Tsung A, Geller DA, Sukato DC et al (2013) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259:549–555CrossRef
17.
Zurück zum Zitat Lai EC, Yang GP, Tang CN (2013) Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205:697–702PubMedCrossRef Lai EC, Yang GP, Tang CN (2013) Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205:697–702PubMedCrossRef
18.
Zurück zum Zitat Lai EC, Tang CN, Li MK (2012) Robot-assisted laparoscopic hemi-hepatectomy: technique and surgical outcomes. Int J Surg 10:11–15PubMedCrossRef Lai EC, Tang CN, Li MK (2012) Robot-assisted laparoscopic hemi-hepatectomy: technique and surgical outcomes. Int J Surg 10:11–15PubMedCrossRef
19.
Zurück zum Zitat Troisi RI, Patriti A, Montalti R et al (2013) Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot Comput Assist Surg 9:160–166CrossRef Troisi RI, Patriti A, Montalti R et al (2013) Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. Int J Med Robot Comput Assist Surg 9:160–166CrossRef
20.
Zurück zum Zitat Packiam V, Bartlett DL, Tohme S et al (2012) Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg 16:2233–2238PubMedCrossRefPubMedCentral Packiam V, Bartlett DL, Tohme S et al (2012) Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg 16:2233–2238PubMedCrossRefPubMedCentral
21.
Zurück zum Zitat Casciola L, Patriti A, Ceccarelli G et al (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25:3815–3824PubMedCrossRef Casciola L, Patriti A, Ceccarelli G et al (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25:3815–3824PubMedCrossRef
22.
Zurück zum Zitat Troisi R, Montalti R, Smeets P et al (2008) The value of laparoscopic liver surgery for solid benign hepatic tumors. Surg Endosc 22:38–44PubMedCrossRef Troisi R, Montalti R, Smeets P et al (2008) The value of laparoscopic liver surgery for solid benign hepatic tumors. Surg Endosc 22:38–44PubMedCrossRef
23.
Zurück zum Zitat Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830PubMedCrossRef Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830PubMedCrossRef
24.
Zurück zum Zitat Tranchart H, Di Giuro G, Lainas P et al (2013) Laparoscopic liver resection with selective prior vascular control. Am J Surg 205:8–14PubMedCrossRef Tranchart H, Di Giuro G, Lainas P et al (2013) Laparoscopic liver resection with selective prior vascular control. Am J Surg 205:8–14PubMedCrossRef
25.
Zurück zum Zitat Dagher I, Caillard C, Proske JM et al (2008) Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg 206:756–760PubMedCrossRef Dagher I, Caillard C, Proske JM et al (2008) Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg 206:756–760PubMedCrossRef
26.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefPubMedCentral Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefPubMedCentral
27.
Zurück zum Zitat Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784PubMedCrossRef Giulianotti PC, Coratti A, Angelini M et al (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784PubMedCrossRef
Metadaten
Titel
Traditional versus Robot-Assisted Full Laparoscopic Liver Resection: A Matched-Pair Comparative Study
verfasst von
Hadrien Tranchart
Cecilia Ceribelli
Stefano Ferretti
Ibrahim Dagher
Alberto Patriti
Publikationsdatum
01.11.2014
Verlag
Springer US
Erschienen in
World Journal of Surgery / Ausgabe 11/2014
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-014-2679-8

Weitere Artikel der Ausgabe 11/2014

World Journal of Surgery 11/2014 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.