Desafío y futuro de la cirugía robótica hepática y pancreática. Análisis de 64 casos en una unidad especializada / Challenge and future of liver and pancreatic robotic surgery. Analysis of 64 cases in a specialized unit

Introducción: La cirugía robótica ha demostrado su eficacia en ciertos procedimientos quirúrgicos. Sin embargo, en cirugía hepática y pancreática (HBP) su uso es todavía poco frecuente. Se presenta la experiencia inicial en cirugía robótica HBP de una unidad especializada en un hospital de tercer nivel. Método: Se han estudiado en forma prospectiva los resultados de los pacientes intervenidos de cirugía HBP robótica entre abril de 2018 y octubre de 2020. Los datos analizados corresponden a datos demográficos, técnicas quirúrgicas realizadas y morbimortalidad asociada. Resultados Se intervinieron 64 pacientes, sometidos a 35 hepatectomías (mayores [6,7%], anatómicas [52,9%], limitadas [34,4%], quistectomías [3%] y marsupializaciones [3%]) y 29 pancreatectomías/resecciones duodenales (distales [48,2%], centrales [6,9%], cefálicas [13,8%], enucleaciones [24,1%], ampulectomías [3,5%] y resecciones duodenales [3,5%]).En cirugía hepática el tiempo operatorio medio fue de 204,4 minutos (100-265 min), la mediana de complicaciones postoperatorias según la escala de Clavien-Dindo fue de uno (1-4), las pérdidas hemáticas medias de 166,7 mL (100-300 mL), no existió conversión y la estancia postoperatoria media de cuatro días (2-14 días).En cirugía pancreática el tiempo operatorio medio fue de 243,8 minutos (125-460 min), la mediana de complicaciones postoperatorias de dos (1-4), las pérdidas hemáticas de 202,3 mL (100-500 mL) asociadas a una tasa de conversión del 17,8% y una estancia media de siete días (3-23 días). Conclusiones: La cirugía robótica HBP es segura y factible. Se sugiere que su uso facilita la cirugía conservadora de parénquima, el acceso a segmentos posteriores hepáticos y la realización de anastomosis en la reconstrucción pancreática respecto a la cirugía laparoscópica (AU)

Introduction: Robotic surgery has proven effective in certain surgical procedures. However, in liver and pancreatic surgery (HBP) its use is still rare. The initial experience in HBP robotic surgery of a specialized unit of a tertiary hospital is presented. results of patients undergoing robotic HBP surgery between April 2018 and October 2020 have been prospectively studied. The data analyzed correspond to demographic data, surgical techniques performed, associated morbidity and mortality.Results64 patients were operated, corresponding to 35 hepatectomies (major [6.7%], anatomic [52.9%], limited [34.4%], cystectomies [3%] and marsupialization [3%]), 29 pancreatectomies (distal [48.2%], central [6.9%], cephalic [13.8%], enucleations [24.1%], ampullectomies [3.5%] and duodenal resections [3.5%]).In liver surgery the mean operative time was 204.4 minutes (100-265 min), the median postoperative complications according to the Clavien-Dindo scale was one (1-4), the mean blood losses 166.7 mL (100-300 mL), there was no conversion and the mean postoperative stay was four days (2-14 days).In pancreatic surgery, the mean operative time was 243.8 minutes (125-460 min), the median of postoperative complications was two (1-4), blood loss of 202.3 mL (100-500 mL) associated to a conversion rate 17.8% and an average stay of seven days (3-23 days).Conclusions: Robotic HBP surgery is safe and feasible. It is suggested that its use facilitates parenchymal sparing surgery, access to posterior liver segments and anastomosis in pancreatic reconstruction compared to laparoscopic surgery (AU)

Challenge and future of liver and pancreatic robotic surgery. Analysis of 64 cases in a specialized unit.

INTRODUCTION: Robotic surgery has proven effective in certain surgical procedures. However, in liver and pancreatic surgery (HBP) its use is still rare. The initial experience in HBP robotic surgery of a specialized unit of a tertiary hospital is presented. METHOD: The results of patients undergoing robotic HBP surgery between April 2018 and October 2020 have been prospectively studied. The data analyzed correspond to demographic data, surgical techniques performed, associated morbidity and mortality. RESULTS: 64 patients were operated, corresponding to 35 hepatectomies (major [6.7%], anatomic [52.9%], limited [34.4%], cystectomies [3%] and marsupialization [3%]), 29 pancreatectomies (distal [48.2%], central [6.9%], cephalic [13.8%], enucleations [24.1%], ampullectomies [3.5%] and duodenal resections [3.5%]). In liver surgery the mean operative time was 204.4 min (100-265 min), the median postoperative complications according to the Clavien-Dindo scale was one (1-4), the mean blood losses 166.7 mL (100-300 mL), there was no conversion and the mean postoperative stay was four days (2-14 days). In pancreatic surgery, the mean operative time was 243.8 min (125-460 min), the median of postoperative complications was two (1-4), blood loss of 202.3 mL (100-500 mL) associated to a conversion rate 17.8% and an average stay of seven days (3-23 days). CONCLUSIONS: Robotic HBP surgery is safe and feasible. It is suggested that its use facilitates parenchymal sparing surgery, access to posterior liver segments and anastomosis in pancreatic reconstruction compared to laparoscopic surgery.

Challenge and future of liver and pancreatic robotic surgery. Analysis of 64 cases in a specialized unit. / Desafío y futuro de la cirugía robótica hepática y pancreática. Análisis de 64 casos en una unidad especializada.

INTRODUCTION: Robotic surgery has proven effective in certain surgical procedures. However, in liver and pancreatic surgery (HBP) its use is still rare. The initial experience in HBP robotic surgery of a specialized unit of a tertiary hospital is presented. METHOD: The results of patients undergoing robotic HBP surgery between April 2018 and October 2020 have been prospectively studied. The data analyzed correspond to demographic data, surgical techniques performed, associated morbidity and mortality. RESULTS: 64 patients were operated, corresponding to 35 hepatectomies (major [6.7%], anatomic [52.9%], limited [34.4%], cystectomies [3%] and marsupialization [3%]), 29 pancreatectomies (distal [48.2%], central [6.9%], cephalic [13.8%], enucleations [24.1%], ampullectomies [3.5%] and duodenal resections [3.5%]). In liver surgery the mean operative time was 204.4 minutes (100-265 min), the median postoperative complications according to the Clavien-Dindo scale was one (1-4), the mean blood losses 166.7 mL (100-300 mL), there was no conversion and the mean postoperative stay was four days (2-14 days). In pancreatic surgery, the mean operative time was 243.8 minutes (125-460 min), the median of postoperative complications was two (1-4), blood loss of 202.3 mL (100-500 mL) associated to a conversion rate 17.8% and an average stay of seven days (3-23 days). CONCLUSIONS: Robotic HBP surgery is safe and feasible. It is suggested that its use facilitates parenchymal sparing surgery, access to posterior liver segments and anastomosis in pancreatic reconstruction compared to laparoscopic surgery.