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

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.

Should cell salvage be used in oncological surgery?

Cell salvage, the process whereby blood is suctioned from the surgical site then filtered, centrifuged and washed before being transfused, was first developed in 1974. Since then it has become a widely used technique which reduces the need for allogenic blood transfusion. Cell salvage was initially considered to be contraindicated in obstetrics, because of the risk of amniotic fluid emboli, in potentially 'dirty' surgical sites and in oncological surgery because of concerns about re-transfusion of malignant cells. However, cell salvage is now routinely used in obstetrics, particularly in massive haemorrhage, and in elective bowel resection. The potential use of cell salvage in oncological surgery has been highlighted following the National Institute for Health and Clinical Excellence (NICE, 2008) guidance sanctioning (although not specifically recommending) cell salvage during radical prostatectomy and cystectomy. This leads to the question of whether cell salvage is safe to use in these and other types of oncological surgery.