RESUMO
BACKGROUND: Few series have reported the utility of fast-track protocols (FTP) in minimally invasive liver surgery. AIM: To report the applicability of FTP in minimally invasive liver surgery and to correlate with difficulty scores. METHODS: The series of patients undergoing minimally invasive liver surgery from 2014 was analyzed. Iwate, Southampton and Gayet's scores were compared as predictors of FTP adherence. Accomplishment of FTP was considered within 24-h, 48-h and 72-h. Multivariate models were performed to define discharge < 24 h, < 72 h, complications and readmissions. RESULTS: From 160 cases, 78 were candidates for FTP, of which 22 (28.2%), 19 (24.4%) and 14 (17.9%) were discharged in < 24-h, 48-h and 72-h, respectively (total = 71.5%). Iwate, Southampton and Gayet's scores achieved area under the receiver operating characteristic values for < 24-h stay of 0.780, 0.687 and 0.698, respectively. Sensitivity and specificity values for the best score (Iwate) were 87.7% and 66.7%, respectively (cutoff = 5.5). In multivariate models, < 72 h stay and complications revealed body mass index as a risk factor independent from difficulty scores. CONCLUSION: The development of aggressive FTP is feasible and < 24-h stay can be achieved even in moderate and advanced complexity cases. Difficulty scores, including body mass index value, may be useful to predict which cases may adhere to these protocols.
RESUMO
BACKGROUND: Liver surgery has traditionally been characterized by the complexity of its procedures and potentially high rates of morbidity and mortality in inexperienced hands. The robotic approach has gradually been introduced in liver surgery and has increased notably in recent years. However, few centers currently perform robotic liver surgery and experiences in robot-assisted surgical procedures continue to be limited compared to the laparoscopic approach. AIM: To analyze the outcomes and feasibility of an initial robotic liver program implemented in an experienced laparoscopic hepatobiliary center. METHODS: A total of forty consecutive patients underwent robotic liver resection (da Vinci Xi, intuitive.com, United States) between June 2019 and January 2021. Patients were prospectively followed and retrospectively reviewed. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed. Data are expressed as mean and standard deviation. The study was approved by the Institutional Review Board. RESULTS: The mean age of patients was 59.55 years, of which 18 (45%) were female. The mean body mass index was 29.41 kg/m². Nine patients (22.5%) were cirrhotic. Patients were divided by type of resection as follows: Ten segmentectomies, three wedge resections, ten left lateral sectionectomies, six bisegmentectomies (two V-VI bisegmentectomies and four IVb-V bisegmentectomies), two right anterior sectionectomies, five left hepatectomies and two right hepatectomies. Malignant lesions occurred in twenty-nine (72.5%) of the patients. The mean operative time was 258.11 min and two patients were transfused intraoperatively (5%). Inflow occlusion was used in thirty cases (75%) and the mean total clamping time was 32.62 min. There was a single conversion due to uncontrollable hemorrhage. Major postoperative complications (Clavien-Dindo > IIIb) occurred in three patients (7.5%) and mortality in one (2.5%). No patient required readmission to the hospital. The mean hospital stay was 5.6 d. CONCLUSION: Although robotic hepatectomy is a safe and feasible procedure with favorable short-term outcomes, it involves a demanding learning curve that requires a high level of training, skill and dexterity.