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OBJECTIVE: To develop a prediction model for major morbidity and endocrine dysfunction after CP which could help in tailoring the use of this procedure. SUMMARY BACKGROUND DATA: Central pancreatectomy (CP) is a parenchyma-sparing alternative to distal pancreatectomy for symptomatic benign and pre-malignant tumors in body and neck of the pancreas CP lowers the risk of new-onset diabetes and exocrine pancreatic insufficiency compared to distal pancreatectomy but it is thought to increase the risk of short-term complications including postoperative pancreatic fistula (POPF). METHODS: International multicenter retrospective cohort study including patients from 51 centers in 19 countries (2010-2021). Primary endpoint was major morbidity. Secondary endpoints included POPF grade B/C, endocrine dysfunction, and the use of pancreatic enzymes. Two risk model were designed for major morbidity and endocrine dysfunction utilizing multivariable logistic regression and internal and external validation. RESULTS: 838 patients after CP were included (301 (36%) minimally invasive) and major morbidity occurred in 248 (30%) patients, POPF B/C in 365 (44%), and 30-day mortality in 4 (1%). Endocrine dysfunction in 91 patients (11%) and use of pancreatic enzymes in 108 (12%). The risk model for major morbidity included male sex, age, BMI, and ASA score≥3. The model performed acceptable with an area under curve (AUC) of 0.72(CI:0.68-0.76). The risk model for endocrine dysfunction included higher BMI and male sex and performed well (AUC:0.83 (CI:0.77-0.89)). CONCLUSIONS: The proposed risk models help in tailoring the use of CP in patients with symptomatic benign and premalignant lesions in the body and neck of the pancreas and are readily available via www.pancreascalculator.com.
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Background: Robotic surgery has revolutionized the field of minimally invasive oncologic surgery. The Da Vinci Xi platform is a significant upgrade from older Da Vinci platforms facilitating multiquadrant and multi-visceral resection. We review the current technical factors and outcomes in robotic surgery for simultaneous resection of colon and synchronous liver metastases (CLRM) and provide future perspective on technical considerations for combined resection. Methods: A literature search on PubMed was performed and relevant studies from January 1st 2009 to January 20th 2023 were identified. Seventy-eight patients who underwent synchronous colorectal and CLRM robotic resection with the Da Vinci Xi were analysed and their indication, technical factors, and post-operative outcomes were studied. Results: The median operative time was 399 minutes and mean blood loss of 180 ml for synchronous resection. Post-operative complications were developed by 71.7% (43/78) patients, 41% being Clavien-Dindo Grade 1 or 2. There was no 30-day mortality reported. Technical factors including port placements and operative factors were presented and discussed for the various permutations of colonic and liver resections performed. Conclusion: Robotic surgery with the Da Vinci Xi platform is a safe and viable approach for simultaneous resection of colon cancer and CLRM. Future studies and sharing of technical experience will potentially facilitate standardization and increased uptake of robotic multi-visceral resection in metastatic liver only colorectal cancer.
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Neoplasias do Colo , Neoplasias Hepáticas , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Humanos , Resultado do Tratamento , Neoplasias Retais/cirurgia , Neoplasias do Colo/cirurgia , Neoplasias Hepáticas/cirurgiaRESUMO
BACKGROUND: Limited liver resections (LLRs) for tumours located in the posterosuperior segments of the liver are technically demanding procedures. This study compared outcomes of robotic (R) and laparoscopic (L) LLR for tumours located in the posterosuperior liver segments (IV, VII, and VIII). METHODS: This was an international multicentre retrospective analysis of patients who underwent R-LLR or L-LLR at 24 centres between 2010 and 2019. Patient demographics, perioperative parameters, and postoperative outcomes were analysed; 1 : 3 propensity score matching (PSM) and 1 : 1 coarsened exact matching (CEM) were performed. RESULTS: Of 1566 patients undergoing R-LLR and L-LLR, 983 met the study inclusion criteria. Before matching, 159 R-LLRs and 824 L-LLRs were included. After 1 : 3 PSM of 127 R-LLRs and 381 L-LLRs, comparison of perioperative outcomes showed that median blood loss (100 (i.q.r. 40-200) versus 200 (100-500) ml; P = 0.003), blood loss of at least 500â ml (9 (7.4 per cent) versus 94 (27.6 per cent); P < 0.001), intraoperative blood transfusion rate (4 (3.1 per cent) versus 38 (10.0 per cent); P = 0.025), rate of conversion to open surgery (1 (0.8 per cent) versus 30 (7.9 per cent); P = 0.022), median duration of Pringle manoeuvre when applied (30 (20-46) versus 40 (25-58) min; P = 0.012), and median duration of operation (175 (130-255) versus 224 (155-300); P < 0.001) were lower in the R-LLR group compared with the L-LLR group. After 1 : 1 CEM of 104 R-LLRs with 104 L-LLRs, R-LLR was similarly associated with significantly reduced blood loss and a lower rate of conversion to open surgery. CONCLUSION: Based on a matched analysis of well selected patients, both robotic and laparoscopic access could be undertaken safely with good outcomes for tumours in the posterosuperior liver segments.
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Carcinoma Hepatocelular , Laparoscopia , Neoplasias Hepáticas , Procedimentos Cirúrgicos Robóticos , Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Tempo de Internação , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Pontuação de Propensão , Estudos RetrospectivosRESUMO
BACKGROUND: Although several non-randomized studies comparing robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) recently demonstrated that the two operative techniques could be equivalent in terms of safety outcomes and short-term oncologic efficacy, no definitive answer has arrived yet to the question as to whether robotic assistance can contribute to reducing the high rate of postoperative morbidity. METHODS: Systematic literature search was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE databases. Prospective and retrospective studies comparing RPD and OPD as surgical treatment for periampullary benign and malignant lesions were included in the systematic review and meta-analysis with no limits of language or year of publication. RESULTS: 18 non-randomized studies were included for quantitative synthesis with 13,639 patients allocated to RPD (n = 1593) or OPD (n = 12,046). RPD and OPD showed equivalent results in terms of mortality (3.3% vs 2.8%; P = 0.84), morbidity (64.4% vs 68.1%; P = 0.12), pancreatic fistula (17.9% vs 15.9%; P = 0.81), delayed gastric emptying (16.8% vs 16.1%; P = 0.98), hemorrhage (11% vs 14.6%; P = 0.43), and bile leak (5.1% vs 3.5%; P = 0.35). Estimated intra-operative blood loss was significantly lower in the RPD group (352.1 ± 174.1 vs 588.4 ± 219.4; P = 0.0003), whereas operative time was significantly longer for RPD compared to OPD (461.1 ± 84 vs 384.2 ± 73.8; P = 0.0004). RPD and OPD showed equivalent results in terms of retrieved lymph nodes (19.1 ± 9.9 vs 17.3 ± 9.9; P = 0.22) and positive margin status (13.3% vs 16.1%; P = 0.32). CONCLUSIONS: RPD is safe and feasible as surgical treatment for malignant or benign disease of the pancreatic head and the periampullary region. Equivalency in terms of surgical radicality including R0 curative resection and number of harvested lymph nodes between the two groups confirmed the reliability of RPD from an oncologic point of view.
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Ampola Hepatopancreática , Neoplasias do Ducto Colédoco/cirurgia , Pancreaticoduodenectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Duração da CirurgiaRESUMO
BACKGROUND: Laparoscopic distal pancreatectomy (LDP) has been adopted relatively slowly despite the benefits of minimally invasive approach. The robotic approach can overcome the limitations of LDP, thus increasing the acceptance of minimally invasive distal pancreatectomy. METHODS: We performed a 1:1 retrospective case-matched comparison among 2 groups of 35 patients who underwent robotic-assisted distal pancreatectomy (RDP) or LDP from August 2014 to April 2017. RESULTS: The operative time was similar in both groups (230 RDP vs. 205 LDP min, p = 0.382). The robotic group had a lower estimated blood loss (95 vs. 275 mL, p = 0.035). The spleen preservation rate was higher in the RDP group (100 vs. 66.7%, p = 0.027), while the conversion rate to open surgery was higher in the laparoscopic group (14.3 vs. 2.9%, p = 0.048). The overall complication rate was lower in the robotic group (25.7 vs. 37.1%, p = 0.044). There was no statistically significant difference in oncologic outcomes between the groups in terms of R0 resection rate (100% RDP vs. 85% LDP, p = 0.233) and number of harvested lymph nodes (14.4 RDP vs. 10.8 LDP, p = 0.678). CONCLUSIONS: The RDP showed a lower estimated blood loss, conversion, and morbidity rate. It offered a higher spleen preservation rate in comparison to LDP while maintaining comparable oncologic outcomes.
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Laparoscopia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: The fluorescence properties of Indocyanine Green (ICG) make it a useful technique in the armamentarium of liver surgeons in order to enhance the visualization of anatomical structures by providing a real-time liver mapping. METHODS: We have analyzed the impact of ICG-fluorescence staining technique in 40 consecutive patients who underwent robotic-assisted liver resection for malignancies from June 2014 to November 2017. RESULTS: For the 55% of patients the surgical indication was colorectal liver metastasis followed by hepatocarcinoma in 35% of cases. The R0 resection rate was 100%, and the mean resection margin was 12 mm. Twenty percent of patients experienced tumor recurrence. The 1-year and 2-year overall survival rates were 91% and 84%, respectively. The 1-year and 2-year disease free survival were 77.2% and 65%, respectively. The previously marked transaction line was changed after the staining method in 12 out of 40 patients. Through intra-operative ultrasonography and white-light exploration of the liver surface 43 lesions were detected, whereas with the ICG-F 52 lesion of the liver surface were identified, including two superficial colorectal metastases missed at the intra-operative ultrasonography. CONCLUSION: The ICG-F is a promising navigational tool, that can potentially overcome the limitations of the minimally invasive liver surgery.
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Corantes , Hepatectomia , Verde de Indocianina , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Estudos de Coortes , Estudos de Viabilidade , Feminino , Fluorescência , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Imagem Óptica , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: The ICG fluorescence properties are progressively gaining momentum in the HPB surgery. However, the exact impact of ICG application on surgical outcomes is yet to be established. METHODS: Twenty-five patients who underwent ICG fluorescence-guided robotic liver resection were case-matched in a 1:1 ratio to a cohort who underwent standard robotic liver resection. RESULTS: In the ICG group, six additional lesions not diagnosed by preoperative workup and intraoperative ultrasound were identified and resected. Four of the lesions were proved to be malignant. Despite the similar operative time (288 vs. 272 min, p = 0.778), the risk of postoperative bile leakage (0% vs. 12%, p = 0.023), R1 resection (0% vs. 16%, p = 0.019) and readmission (p = 0.023) was reduced in the ICG group compared with the no-ICG group. CONCLUSIONS: The ICG fluorescence is a real-time navigation tool which enables surgeons to enhance visualization of anatomical structures and overcome the disadvantages of minimally invasive liver resection. The procedure is not time-consuming, and its applications can reduce the postoperative complication rate in robotic liver surgery.
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Hepatectomia/métodos , Verde de Indocianina , Fígado/diagnóstico por imagem , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Feminino , Fluorescência , Hepatectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Robóticos/efeitos adversosRESUMO
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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Hepatectomia/métodos , Laparoscopia/métodos , Curva de Aprendizado , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Competência Clínica , Estudos de Viabilidade , Hepatectomia/normas , Humanos , Laparoscopia/normas , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/normasRESUMO
BACKGROUND: Described for the first time in 2003, the robotic pancreatic surgery shows interesting results. The evaluation of post-operative outcomes is necessary once we describe an innovative surgical approach. METHODS: We have performed a retrospective analysis of a prospectively maintained database on robotic pancreatic surgery including malignant and benign indications for surgery. RESULTS: A total of 50 consecutive patients underwent robotic pancreatic surgery (26 pancreatico duodenectomy and 24 distal pancreatectomy) between January 2012 and July 2015 in a single centre. The overall operative time was 425 (390-620) min. In a subgroup of highly selected malignant tumours, we were able to achieve 88% of R0 resection with robotic approach. A number of lymphnodes rose significantly with growing experience (p = .025). The overall major complication rate (15%), as well as pancreatic fistula rate (16%) were acceptable. The two-year overall survival for the whole group was 65%. CONCLUSION: The robotic pancreatic surgery in a highly selected group of patients seems safe and feasible. The cost-effectiveness and long-term oncologic outcomes need further investigations.
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Pancreatopatias/cirurgia , Pancreaticoduodenectomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pancreatectomia , Pancreatopatias/mortalidade , Pancreaticoduodenectomia/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: Robotic surgery is currently employed for many surgical procedures, yielding interesting results. METHODS: We performed an historical review of robots and robotic surgery evaluating some critical phases of its evolution, analyzing its impact on our life and the steps completed that gave the robotics its current popularity. RESULTS: The origins of robotics can be traced back to Greek mythology. Different aspects of robotics have been explored by some of the greatest inventors like Leonardo da Vinci, Pierre Jaquet-Droz, and Wolfgang Von-Kempelen. Advances in many fields of science made possible the development of advanced surgical robots. Over 3000 da Vinci robotic platforms are installed worldwide, and more than 200 000 robotic procedures are performed every year. CONCLUSION: Despite some potential adverse events, robotic technology seems safe and feasible. It is strictly linked to our life, leading surgeons to a new concept of surgery and training.
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Procedimentos Cirúrgicos Robóticos , Automação , História do Século XV , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , História Medieval , Humanos , Procedimentos Cirúrgicos Robóticos/história , Procedimentos Cirúrgicos Robóticos/instrumentação , Procedimentos Cirúrgicos Robóticos/métodosAssuntos
Curva de Aprendizado , Pancreaticoduodenectomia/educação , Procedimentos Cirúrgicos Robóticos/educação , Humanos , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/normas , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Cirurgiões/educaçãoRESUMO
Background: With the rapid development of robotic surgery, especially for the abdominal surgery, robotic pancreatic surgery (RPS) has been applied increasingly around the world. However, evidence-based guidelines regarding its application, safety, and efficacy are still lacking. To harvest robust evidence and comprehensive clinical practice, this study aims to develop international guidelines on the use of RPS. Methods: World Health Organization (WHO) Handbook for Guideline Development, GRADE Grid method, Delphi vote, and the AGREE-II instrument were used to establish the Guideline Steering Group, Guideline Development Group, and Guideline Secretary Group, formulate 19 clinical questions, develop the recommendations, and draft the guidelines. Three online meetings were held on 04/12/2020, 30/11/2021, and 25/01/2022 to vote on the recommendations and get advice and suggestions from all involved experts. All the experts focusing on minimally invasive surgery from America, Europe and Oceania made great contributions to this consensus guideline. Results: After a systematic literature review 176 studies were included, 19 questions were addressed and 14 recommendations were developed through the expert assessment and comprehensive judgment of the quality and credibility of the evidence. Conclusions: The international RPS guidelines can guide current practice for surgeons, patients, medical societies, hospital administrators, and related social communities. Further randomized trials are required to determine the added value of RPS as compared to open and laparoscopic surgery.
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INTRODUCTION: Despite the potential advantages in terms of microdissection and microsuturing capabilites, the robotic approach for borderline resectable pancreatic cancer is scarcely reported. METHODS: We report our technique for a robotic-assisted pancreaticoduodenectomy with tangential Portal/ Superior Mesenteric Vein resection/reconstruction (RPD PV/SMV).We also compared the surgical outcomes of eight consecutive patients undergoing RPD PV/SMV with that of sixty patients who underwent robotic-assisted pancreaticoduodenectomy (RPD) in the same period of time. RESULTS: A total of eight consecutive patients underwent RPD PV/SMV. We observed an increased estimated blood loss (550 vs 280 mL, p = 0.003) and operative time (438 vs 350 min, p = 0.002) in the RPD PV/SMV group of patients compared with RPD group, whereas the complication rate (28% vs 31%, p = 0.726) was similar. No venous-congestion related complications were observed in the postoperative course. The median length of hospital stay was similar in the RPD group in comparison to that in the RPD PV/SMV group (10 vs 13 range 6-19 days, p = 0.313). CONCLUSION: RPD PV/SMV is a challenging operation. It is associated with higher operative time and increased estimated blood loss in comparison to standard RPD.
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Neoplasias Pancreáticas , Procedimentos Cirúrgicos Robóticos , Humanos , Veias Mesentéricas/cirurgia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Veia Porta/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do TratamentoRESUMO
PURPOSE: Little is known about the sporadic coincidence of gastrointestinal stromal tumors (GISTs) with second primary tumors (SPTs). The aim of this study is to clarify if there is a clinicopathologic correlation responsible for the synchronous or metachronous occurrence of SPTs in GIST patients. METHODS: We carried out a single-center, retrospective analysis on patients with GISTs surgically treated at our institution from January 2019 to June 2019. Two groups of patients were identified: isolated GIST (group A) and GIST associated with SPT (group B). A meta-review was conducted with the aim to examine the published systematic reviews that included studies assessing the SPT risk in GIST patients. RESULTS: Thirty-nine patients were surgically treated for GIST during the study period, with seven (17.9%) of them having other SPTs. SPTs were most frequent in the colon. Group A patients had a lower mean age at initial diagnosis (56.8 ± 15.2 vs. 73.4 ± 16.6, P = 0.012). No statistically significant difference was found between the two groups in terms of tumor location, mitotic index, Ki-67 expression, risk classification, and imatinib therapy. The overview showed that the cumulative prevalence rate of SPTs ranged from 9.3 to 18.0%. SPTs were more frequent in the gastrointestinal tract (37.9-95.0%), followed by the genitourinary tract. CONCLUSION: GIST patients under our care experienced a 17.9% overall risk of developing SPTs with different histology. When comparing patients with isolated GIST and patients with GIST and SPT, age was the only variable significantly related to the development of other neoplasms. However, the potential non-random association and causal relationship between GISTs and SPTs remain to be investigated.
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Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal , Segunda Neoplasia Primária/patologia , Revisões Sistemáticas como Assunto , Idoso , Feminino , Seguimentos , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/cirurgia , Prognóstico , Estudos RetrospectivosRESUMO
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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Pancreaticoduodenectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Robóticos/métodos , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fístula Pancreática/epidemiologia , Fístula Pancreática/prevenção & controle , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Despite the potential benefits, the adoption of the minimally invasive surgery for the treatment of borderline resectable pancreatic cancer is still in the initial phase. We investigated the safety and feasibility of the robotic pancreaticoduodenectomy with venous resection/reconstruction (RPD SMV/PV). METHODS: Since March 2013 to October 2019, a total of 73 RPD and 10 RPD SMV/PV were performed. The two groups were case-matched according to the preoperative characteristics. RESULTS: Mean operative times and estimated blood loss were less in the RPD group in comparison to that in the RPD with SMV-PV group (525 vs 642 min, p = 0.003 and 290 vs 620 ml, p = 0.002, respectively). The mean length of hospital stay was similar in the RPD group in comparison to that in the RPD with SMV-PV group (10 days vs 13 days, p = 0.313). The two groups had similar overall postoperative morbidity rate (57.5% vs 60%, p = 0.686), although the severe complication rate was lower in the RPD group (11% vs 40%, p = 0.004). CONCLUSIONS: RPD with SMV-PV is associated with increased operative time, estimated blood loss, higher major complication rate compared with RPD.
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Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/métodos , Pancreaticoduodenectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adenocarcinoma/patologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricosRESUMO
Robotic liver surgery has been considered as a unique opportunity to overcome the traditional limitations of laparoscopy; thus, it can potentially extend the indications of minimally invasive liver surgery. From April 2015 to May 2017, 35 patients underwent fully robotic left hepatectomy. The mean operative time was 315 min (200-445 min) and the mean estimated blood loss was 245 ml (125-628 ml). Pringle maneuver was required in six cases. Cancer was the indication for surgery in all patients (14 liver metastases, 18 hepatocellular carcinomas and 3 cholangiocarcinomas). There were one to four lesions in a patient and the mean lesion size was 39.2 mm (15-85 mm). The average length of hospital stay was 6.5 days (5-14 days). Perioperative morbidity rate was 17.2%. Two patients underwent conversion to open surgery. The 90-day mortality rate was nil. The mean surgical resection margin was 12 (1-22) mm, and R0-resection was reached in 33 out of 35 cases. The robotic left hepatectomy provides interesting surgical outcomes and good oncologic adequacy. It can be safely applied for the management of liver malignancies.
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Carcinoma Hepatocelular/cirurgia , Colangiocarcinoma/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação , Margens de Excisão , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: The application of indocyanine green (icg) properties in the field of HPB surgery is gaining momentum. The adoption of the staining technique for the visualization of hepatic liver parenchyma is still preliminary. METHODS: We performed a 1:1 case- matched comparison among 20 patients who underwent robotic liver resection with or without the application of icg fluorescence. RESULTS: The icg enabled the reduction of postoperative liver abscess and bile leakage rate. The staining technique was not time-consuming and provided excellent enhancement of liver transection line. CONCLUSION: The routine use of icg-fluorescence could potentially reduce the postoperative complications during robotic liver surgery.
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Hepatectomia/métodos , Verde de Indocianina/farmacologia , Neoplasias Hepáticas/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Assistida por Computador/métodos , Corantes/farmacologia , Humanos , Neoplasias Hepáticas/diagnósticoRESUMO
BACKGROUND: Bile duct injury after cholecystectomy can be a life-threatening complication. Use of robotic approach to manage a complex biliary injury is in an early phase. METHODS: We have performed an analysis of our prospectively maintained database that included 12 patients who underwent robotic-assisted repair of bile duct injury after laparoscopic cholecystectomy between 2014 and 2017. RESULTS: All patients underwent robotic biliary repair within 2 weeks after primary injury. No conversion to open surgery was necessary, the estimated mean blood loss was 252 mL, and the mean operative time was 260 minutes. The mean length of stay was 9.4 days. The 30-day complication events were a subhepatic abscess and a recurrent episode of cholangitis. One patient underwent the reoperation. The mortality was null. CONCLUSION: Robotic-assisted bile duct injury repair seems to be safe and feasible. It offers promising results, thus potentially capable of modifying the management of biliary injury.
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Colecistectomia Laparoscópica/métodos , Ducto Colédoco/cirurgia , Complicações Intraoperatórias , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Colecistectomia , Ducto Colédoco/lesões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reoperação , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The robotic surgical system has been applied to various types of pancreatic surgery. However, controversies exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. This study aimed to evaluate the current status of robotic pancreatic surgery and put forth experts' consensus and recommendations to promote its development. Based on the WHO 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 19 topics were analyzed. The first 16 recommendations were generated by GRADE using an evidence-based method (EBM) and focused on the safety, feasibility, indication, techniques, certification of the robotic surgeon, and cost-effectiveness of robotic pancreatic surgery. The remaining three recommendations were based on literature review and expert panel opinion due to insufficient EBM results. Since the current amount of evidence was low/meager as evaluated by the GRADE method, further randomized controlled trials (RCTs) are needed in the future to validate these recommendations.