ABSTRACT
Background This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. Methods A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 7579 years old; group 2: 8084 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. Results Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). Conclusions No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications. (AU)
Antecedentes Este estudio fue diseñado para analizar la influencia de la edad y la evaluación geriátrica integral en los resultados clínicos del manejo de la enfermedad pancreatobiliar en pacientes de edad avanzada. Métodos Se ha realizado un estudio observacional prospectivo en el que se incluyeron 140 pacientes de edad avanzada (mayores de 75 años) con enfermedad pancreatobiliar benigna. Los pacientes se dividieron según la edad en los siguientes grupos: Grupo 1: 75-79 años; Grupo 2: 80-84 años; Grupo 3: 85 años y más. Se les realizó una valoración geriátrica integral con diferentes escalas: Barthel Index, Pfeiffer Index, Charlson Index y Fragility scale, al ingreso y seguimiento 90 días después del alta hospitalaria para analizar su influencia en la morbimortalidad. Resultados En total, se incluyeron 140 pacientes (Grupo 1=51; Grupo 2=43 y Grupo 3=46). La mayoría de ellos, 52 casos (37,8%), presentaron colecistitis aguda, seguido de colangitis aguda con 29 casos (20,2%) y pancreatitis aguda con 25 casos (17,9%). Se han observado diferencias significativas en las complicaciones en diferentes grupos de edad (p=0,033). Especialmente en pacientes con un índice de Barthel ≤60, lo que sugiere que estos pacientes menos funcionales tuvieron complicaciones más severas después de su tratamiento (p=0,037). La tasa de mortalidad fue de 7,1% (10 pacientes). Conclusiones No se encontraron diferencias significativas entre la edad, la morbilidad y la mortalidad en pacientes ancianos con enfermedad pancreatobiliar. Las escalas geriátricas integrales mostraron cierta utilidad en su asociación con complicaciones específicas. (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , /diagnosis , /mortality , Morbidity , /surgery , Prospective StudiesSubject(s)
Abdominal Injuries , Laparoscopy , Pancreatic Neoplasms , Wounds, Nonpenetrating , Humans , Pancreatectomy , Spleen/surgery , Spleen/injuries , Pancreatic Neoplasms/surgery , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/surgery , Abdominal Injuries/complications , Abdominal Injuries/surgerySubject(s)
Humans , Male , Female , Pancreatectomy , General Surgery , Laparoscopy , Abdominal Injuries/surgery , LacerationsSubject(s)
Humans , Male , Female , Pancreatectomy , Laparoscopy , Robotic Surgical Procedures , Pancreatic Fistula , Minimally Invasive Surgical ProceduresSubject(s)
Consensus , Delphi Technique , Terminology as Topic , Humans , Pancreatectomy/standards , Pancreatic Neoplasms/surgeryABSTRACT
The use of the robotic approach in liver surgery is exponentially increasing. Although technically the robot introduces several innovative features, the instruments linked with the traditional laparoscopic approach for the liver parenchymal transection are not available, which may result in multiple technical variants that may bias the comparative analysis between the different series worldwide. A real robotic approach, minimally efficient for the liver parenchymal transection, with no requirement of external tool, available for the already existing platforms, and applicable to any type of liver resection, counting on the selective use of the plugged bipolar forceps and the monopolar scissors, or "microfracture-coagulation" (MFC) transection method, is described in detail. The relevant aspects of the technique, its indications and methodological basis are discussed.
Subject(s)
Fractures, Stress , Robotic Surgical Procedures , Robotics , Humans , Robotic Surgical Procedures/methods , Liver/surgery , HepatectomyABSTRACT
OBJECTIVE: To develop and update evidence-based and consensus-based guidelines on laparoscopic and robotic pancreatic surgery. SUMMARY BACKGROUND DATA: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update. METHODS: Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, and the AGREE II-GRS tool for guideline quality assessment and external validation by a Validation Committee. RESULTS: Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the 2-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic, and 31 on general MIPS, covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee. CONCLUSIONS: The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers, and medical societies.
Subject(s)
Laparoscopy , Surgeons , Humans , Artificial Intelligence , Pancreas/surgery , Minimally Invasive Surgical Procedures/methods , Laparoscopy/methodsABSTRACT
Introducción: Análisis de los resultados de resección venosa en cirugía pancreática oncológica de 2 centros de referencia. Se analiza el tipo de intervención realizada, los tipos de reconstrucción vascular, el estudio anatomopatológico, la morbimortalidad postoperatoria y la supervivencia a 3 y 5 años. Métodos: Análisis retrospectivo, transversal y comparativo. Se incluyen 41 pacientes intervenidos de lesiones neoplásicas pancreáticas desde 2003 hasta 2021 que requirieron resección venosa por afectación vascular. Resultados: La técnica quirúrgica más frecuente fue la duodenopancreatectomía cefálica tipo Whipple, realizada en 35 de los 41 pacientes (85%). Uno de los casos se realizó por acceso laparoscópico. La reconstrucción vascular tipo 1 (sutura simple) se realizó en 11 pacientes (27%), la tipo 2 (patch de falciforme) en 4 casos (10%), la tipo 3 (sutura término-terminal) en 23 casos (56%) y la reconstrucción tipo 4 (injerto autógeno) en 3 casos (7%). La longitud media del segmento venoso resecado fue de 21mm (11-46) y el tiempo quirúrgico medio fue de 290min (220-360). El 90% (37/41) fueron adenocarcinoma de páncreas. El 83% se consideraron R0 y hubo afectación en el tramo vascular resecado en el 41% de los casos. Hubo morbilidad Clavien-Dindo>3 en 4 pacientes y no hubo ningún caso de mortalidad postoperatoria. La supervivencia a 3 años fue del 48% y a 5 años del 20%. Conclusiones: La resección venosa con reconstrucción para asegurar una resección R0 es una técnica factible, con una aceptable tasa de morbimortalidad y supervivencia global. (AU)
Introduction: To report the clinical results of patients with malignant pancreatic lesions who underwent oncological surgery with vascular resection. The type of intervention performed, the types of vascular reconstruction, the pathological anatomy results, postoperative morbidity and mortality, and survival at 3 and 5 years were analysed. Methods: Retrospective, cross-sectional and comparative analysis. We include 41 patients with malignant pancreatic lesions who underwent surgery with vascular resection due to vascular involvement, from 2013 to 2021. Results: The most performed surgery was the cephalic pancreaticoduodenectomy (Whipple procedure) using median laparotomy, in 35 of the 41 patients (85%). One of the cases in the series was performed laparoscopically. Type 1 reconstruction (simple suture) was performed in 11 (27%) patients, type 2 in 4 (10%) cases, type 3 (TT suture) in 23 (56%) cases, and type 4 reconstruction by autologous graft in 3 (7%) cases. The mean length of the resected venous segment was 21 (1146)mm and the mean surgical time was 290 (220360)min. 90% (37/41) were pancreatic adenocarcinoma. 83% were considered R0 and there was involvement in the resected vascular section in 41% of the cases. Four patients had Clavien-Dindo morbidity>3 and there were no cases of postoperative mortality. Survival at 3 years was 48% and at 5 years was 20%. Conclusions: The aggressive surgical treatment with venous resection in pancreatic malignant lesions to ensure R0 and its vascular reconstruction is a feasible technique, with an acceptable morbid-mortality rate and overall survival. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Pancreas/surgery , Pancreatic Neoplasms/surgery , Cross-Sectional Studies , Retrospective Studies , AdenocarcinomaABSTRACT
Introducción El nivel de recomendación del abordaje robótico en la cirugía hepática es controvertido. Se realiza un análisis descriptivo, retrospectivo yunicéntrico de los resultados a corto plazo de la cirugía hepática robótica y laparoscópica en un mismo periodo.MétodosAnálisis descriptivo del abordaje robótico y laparoscópico sobre 220 resecciones en 182 pacientes sometidos a cirugía hepática mínimamente invasiva.ResultadosEntre abril de 2018 y junio de 2022 se realizaron 92 resecciones hepáticas robóticas (RHR) en 83 pacientes y 128 laparoscópicas (RHL) en 99 pacientes. Se observaron más resecciones mayores (p<0,001) y más resecciones múltiples (p=0,002) en el grupo CHL. El porcentaje de resecciones anatómicas fue similar (RHR: 64,1 vs. RHL: 56,3%). En el grupo CHL el tiempo medio operatorio fue de 212min (DE: 52,1), las pérdidas hemáticas de 276,5ml (100-1.000) y la tasa de conversión del 12,1%. La estancia media hospitalaria fue de 5,7 días (DE: 4,9), la morbilidad fue del 27,3%, con un 2% de mortalidad. En el grupo CHR el tiempo medio operatorio fue de 217min (DE: 53,6), las pérdidas hemáticas fueron de 169,5ml (100-900) y la tasa de conversión del 2,5%. La estancia media hospitalaria fue de 4,1 días (DE: 2,1) y la morbilidad fue del 15%, con mortalidad nula.ConclusiónLa cirugía mínimamente invasiva hepática es una técnica segura y reproducible. La CHR permite realizar resecciones hepáticas con seguridad y parece ser una técnica no inferior a la CHL, pero para determinar el abordaje mínimamente invasivo de elección en cirugía hepática se requieren estudios aleatorizados. (AU)
Introduction The level of recommendation of the robotic approach in liver surgery is controversial. The objective of the study is to carry out a single-center retrospective descriptive analysis of the short-term results of the robotic and laparoscopic approach in liver surgery during the same period.MethodsDescriptive analysis of the short-term results of the robotic and laparoscopic approach on 220 resections in 182 patients undergoing minimally invasive liver surgery.ResultsBetween April 2018 and June 2022, a total of 92 robotic liver resections (RLR) were performed in 83 patients and 128 laparoscopic (LLR) in 99 patients. The LLR group showed a higher proportion of major surgery (P<.001) and multiple resections (P=.002). The two groups were similar in anatomical resections (RLR 64.1% vs. LLR 56.3%). In the LLS group, the average operating time was 212min (SD 52.1). Blood loss was 276.5ml (100-1000) and conversion 12.1%. Mean hospital stay was 5.7 (SD 4.9) days. Morbidity was 27.3% and 2% mortality. In the RLS group, the mean operative time was 217min (SD 53.6), blood loss 169.5ml (100.900), and conversion 2.5%. Mean hospital stay was 4.1 (SD 2.1) days. Morbidity was 15%, with no mortality.ConclusionMinimally invasive liver surgery is a safe technique, and in particular, RLS allows liver resections to be performed safely and reproducibly; it appears to be a non-inferior technique to LLS, but randomized studies are needed to determine the minimally invasive approach of choice in liver surgery. (AU)
Subject(s)
Humans , Robotic Surgical Procedures/adverse effects , Robotic Surgical Procedures/instrumentation , Laparoscopy , Epidemiology, Descriptive , Retrospective Studies , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/instrumentationABSTRACT
Introducción La pancreatectomía distal (PD) mínimamente invasiva (MIS) está actualmente bien establecida, ya sea mediante técnica laparoscópica (PDL) o robótica (PDR).MétodosDe 83 PD realizadas entre enero del 2018 y marzo del 2022, se realizaron 57 casos (68,7%) mediante MIS, 35 PDL y 22 PDR (da Vinci Xi). Se evalúa la experiencia de ambos procedimientos y el valor del abordaje robótico. Se analizan en detalle los casos de conversión.ResultadosEl tiempo quirúrgico medio en las PDL y PDR fue de 201,2 (DE 47,8) y 247,54 (DE 35,8) min, (p=0,486). No se observaron diferencias en estancia hospitalaria ni en tasa de conversión, 6 (5-34) vs. 5,6 (5-22) días y 4 (11,4%) vs. 3 (13,6%) casos, respectivamente, (p=0.126). La tasa de reingresos fue de 3/35 (11,4%) y 6/22 (27,3%) casos, PDL vs. PDR respectivamente, (p=0.126).No existieron diferencias en morbilidad (Dindo-Clavien ≥ III) entre ambos grupos. La mortalidad fue de un caso en el grupo robótico (un paciente con conversión precoz por afectación vascular). La tasa de resecciones R0 fue mayor en el grupo robótico (77,1% vs. 90,9%) alcanzando la significación estadística, p=0,04.ConclusionesLa PDMIS es un procedimiento seguro y factible en pacientes seleccionados. Una planificación quirúrgica y la implementación escalonada basada en la experiencia previa ayudan a afrontar procedimientos técnicamente exigentes. Se sugiere que la PDR podría ser el abordaje de elección en la pancreatectomía corporocaudal, no siendo inferior a la PDL. (AU)
Introduction Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach.MethodsOut of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the 2techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail.ResultsThe mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8)min, respectively (p=0,486). No differences were observed in length of hospital stay or conversion rate: 6 (534) vs. 5.6 (522) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (p=0.126). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (p=0.126).There were no differences in morbidity (Dindo-Clavien≥III) between the 2groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P=,04).ConclusionsMinimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP. (AU)
Subject(s)
Humans , Pancreatectomy/adverse effects , Pancreatectomy/trends , Minimally Invasive Surgical Procedures , Pancreatic Neoplasms/rehabilitation , Pancreatic Neoplasms/surgery , Laparoscopy , Robotic Surgical ProceduresABSTRACT
BACKGROUND: This study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. METHODS: A prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75-79 years old; group 2: 80-84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. RESULTS: Overall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). CONCLUSIONS: No significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.
ABSTRACT
La realidad aumentada es una tecnología que abre nuevas posibilidades en cirugía. Se presenta su implementación en una unidad de cirugía hepato-bilio-pancreática en relación con la planificación preoperatoria, el soporte intraoperatorio y la docencia. Para la planificación quirúrgica se han utilizado reconstrucciones 3D de la TC y de la RMN para hacer una evaluación de casos complejos, siendo la interpretación de la anatomía más precisa, y la planificación de la técnica más simple. A nivel intraoperatorio ha permitido la conexión remota holográfica entre especialistas, la substitución de elementos físicos por elementos virtuales, y el uso de modelos virtuales de consulta y guía quirúrgica. En docencia se han impartido clases que incluyen la retransmisión de una cirugía con el soporte de elementos virtuales para una mejor comprensión por parte de los estudiantes. Siendo la experiencia satisfactoria, la realidad aumentada podría aplicarse en el futuro de la cirugía hepato-bilio-pancreática para mejorar sus resultados. (AU)
Augmented reality is a technology that opens new possibilities in surgery. Its implementation in a hepatobiliary-pancreatic surgery unit is presented in relation to preoperative planning, intraoperative support and teaching. For surgical planning, 3D CT and MRI reconstructions have been used to evaluate complex cases, making the interpretation of the anatomy more precise and the planning of the technique simpler. At an intraoperative level, it has allowed remote holographic connection between specialists, the substitution of physical elements for virtual elements, and the use of virtual consultation models and surgical guides. In teaching, new lessons include the retransmission of a surgery with the support of virtual elements for a better understanding by the students. Being the experience satisfactory, augmented reality could be applied in the future of hepatobiliary-pancreatic surgery to improve its results. (AU)
Subject(s)
Humans , General Surgery/education , Diffusion of Innovation , 57943 , Pancreas/surgery , Bile Ducts/surgeryABSTRACT
Introducción: La estrategia inversa (EI) es un esquema indicado en pacientes con cáncer colorrectal (CCR) y metástasis hepáticas sincrónicas (MHS) avanzadas. Incluye quimioterapia neoadyuvante, seguido de resección hepática y, por último, resección del CCR. Material: Estudio descriptivo retrospectivo sobre una base de datos prospectiva de hepatectomías por metástasis hepáticas de CCR en 2 centros entre 2007 y 2019. Se incluyeron 88 pacientes con CCR y MHS. La enfermedad hepática fue bilobar en un 65,9%, el número y el tamaño medio de las lesiones fue de 5,5 y 42,7mm, respectivamente. La respuesta radiológica al tratamiento se evaluó mediante criterios RECIST. La supervivencia libre de progresión (SLP) y la supervivencia global (SG) media se estimaron mediante el método de Kaplan-Meier y regresión de Cox.Resultados: De los 88 pacientes, 75 completaron la EI (85,2%). La respuesta radiológica fue parcial en el 75,7% y la estabilización en el 22,8%. La tasa de morbilidad (Clavien-Dindo ≥IIIA) tras la cirugía hepática y colorrectal fue del 29,4 y 9,3%, respectivamente. No hubo mortalidad a los 90 días. La tasa de recurrencia fue del 76%. Se diagnosticaron 106 recurrencias en 56 pacientes. De estos, se realizó tratamiento quirúrgico asociado a quimioterapia en 34 (32,1%). La SLP fue de 8,5 meses y la SG a 5 años fue del 53%. Conclusiones: En pacientes con CCR y MHS la EI permite el control inicial de la enfermedad metastásica, seleccionar pacientes respondedores a la neoadyuvancia y optimizar las posibilidades de resección completa, influyendo en la supervivencia a largo plazo. (AU)
Background: The liver-first approach (LFA) is a strategy indicated for advanced synchronous liver metastases (ASLM) from colorectal cancer (CRC). Includes neoadjuvant chemotherapy, resection of the ASLM followed by CRC resection.Methods: Retrospective descriptive analysis from a prospective database of hepatectomies from liver metastases (LM) from CRC in two centers. Between 2007-2019, 88 patients with CRC-ASLM were included in a LFA scheme. Bilobar (LM) was present in 65.9%, the mean number of lesions was 5.5 and mean size 42.7mm. Response to treatment was assessed by RECIST criteria. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier survival curves. Results: Seventy-five of 88 patients (85.2%) completed the LFA. RECIST evaluation showed partial response in 75.7% and stable disease in 22.8%. Severe morbidity rate (ClavienDindo ≥ IIIA) after liver and colorectal surgery was present in 29.4% and 9.3%, respectively. There was no 90-day postoperative mortality in both liver and colorectal surgeries. Recurrence rate was 76%, being the liver the most frequent site, followed by the pulmonary. From the total number of recurrences (106) in 56 patients, surgical with chemotherapy rescue treatment was accomplished in 34 of them (32.1%). The mean PFS was 8.5 and 5-year OS was 53%. Conclusions: In patients with CRC-ASLM the LFA allows control of the liver disease beforehand and an assessment of the tumor response to neoadjuvant chemotherapy, optimising the chance of potentially curative liver resection, which influences long-term survival. (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Colorectal Neoplasms , Liver Diseases , Liver Neoplasms , Retrospective Studies , Epidemiology, Descriptive , Neoadjuvant TherapyABSTRACT
INTRODUCTION: The level of recommendation of the robotic approach in liver surgery is controversial. The objective of the study is to carry out a single-center retrospective descriptive analysis of the short-term results of the robotic and laparoscopic approach in liver surgery during the same period. METHODS: Descriptive analysis of the short-term results of the robotic and laparoscopic approach on 220 resections in 182 patients undergoing minimally invasive liver surgery. RESULTS: Between April 2018 and June 2022, a total of 92 robotic liver resections (RLR) were performed in 83 patients and 128 laparoscopic (LLR) in 99 patients. The LLR group showed a higher proportion of major surgery (P < .001) and multiple resections (P = .002). The two groups were similar in anatomical resections (RLR 64.1% vs. LLR 56.3%). In the LLS group, the average operating time was 212 min (SD 52.1). Blood loss was 276.5 mL (100-1000) and conversion 12.1%. Mean hospital stay was 5.7 (SD 4.9) days. Morbidity was 27.3% and 2% mortality. In the RLS group, the mean operative time was 217 min (SD 53.6), blood loss 169.5 mL (100.900), and conversion 2.5%. Mean hospital stay was 4.1 (SD 2.1) days. Morbidity was 15%, with no mortality. CONCLUSION: Minimally invasive liver surgery is a safe technique, and in particular, RLS allows liver resections to be performed safely and reproducibly; it appears to be a non-inferior technique to LLS, but randomized studies are needed to determine the minimally invasive approach of choice in liver surgery.
Subject(s)
Robotic Surgical Procedures , Humans , Retrospective Studies , Liver , Minimally Invasive Surgical Procedures , HepatectomyABSTRACT
INTRODUCTION: Distal pancreatectomy (DP) is currently well established as a minimally invasive surgery (MIS) procedure, using either a laparoscopic (LDP) or robotic (RDP) approach. METHODS: Out of 83 DP performed between January 2018 and March 2022, 57 cases (68.7%) were performed using MIS: 35 LDP and 22 RDP (da Vinci Xi). We have assessed the experience with the two techniques and analyzed the value of the robotic approach. Cases of conversion have been examined in detail. RESULTS: The mean operative times for LDP and RDP were 201.2 (SD 47.8) and 247.54 (SD 35.8) minutes, respectively (P = NS). No differences were observed in length of hospital stay or conversion rate: 6 (5-34) vs. 5.6 (5-22) days, and 4 (11.4%) vs. 3 (13.6%) cases, respectively (P = NS). The readmission rate was 3/35 patients (11.4%) treated with LDP and 6/22 (27.3%) cases of RDP (P = NS). There were no differences in morbidity (Dindo-Clavien ≥ III) between the two groups. Mortality was one case in the robotic group (a patient with early conversion due to vascular involvement). The rate of R0 resection was greater and statistically significant in the RDP group (77.1% vs. 90.9%) (P = .04). CONCLUSION: Minimally invasive distal pancreatectomy (MIDP) is a safe and feasible procedure in selected patients. Surgical planning and stepwise implementation based on prior experience help surgeons successfully perform technically demanding procedures. RDP could be the approach of choice in distal pancreatectomy, and it is not inferior to LDP.
Subject(s)
Laparoscopy , Robotic Surgical Procedures , Humans , Pancreatectomy , Length of Stay , Operative TimeABSTRACT
Augmented reality is a technology that opens new possibilities in surgery. We present our experience in a hepatobiliary-pancreatic surgery unit in terms of preoperative planning, intraoperative support and teaching. For surgical planning, we have used 3D CT and MRI reconstructions to evaluate complex cases, which has made the interpretation of the anatomy more precise and the planning of the technique simpler. At an intraoperative level, it provides for remote holographic connection between specialists, the substitution of physical elements for virtual elements, and the use of virtual consultation models and surgical guides. In teaching, new lessons include sharing live video of surgery with the support of virtual elements for a better student understanding. As the experience has been satisfactory, augmented reality could be applied in the future to improve the results of hepatobiliary-pancreatic surgery.