Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2022; 14(1): 224-233
Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.224
Short-term outcomes of robotic liver resection: An initial single-institution experience
Manuel Durán, Javier Briceño, Ana Padial, Ferdinando Massimiliano Anelli, Juan Manuel Sánchez-Hidalgo, María Dolores Ayllón, Rafael Calleja-Lozano, Carmen García-Gaitan
Manuel Durán, Javier Briceño, Ana Padial, Ferdinando Massimiliano Anelli, Juan Manuel Sánchez-Hidalgo, María Dolores Ayllón, Rafael Calleja-Lozano, Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Cordoba 14004, Spain
Manuel Durán, Javier Briceño, Ana Padial, Ferdinando Massimiliano Anelli, María Dolores Ayllón, Rafael Calleja-Lozano, GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
Juan Manuel Sánchez-Hidalgo, GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute, Córdoba 14004, Spain
Carmen García-Gaitan, Department of Anesthesiology and Resuscitation, Reina Sofia University Hospital, Cordoba 14004, Spain
Author contributions: Durán M and Briceño J have contributed equally to this paper; Briceño J was the principal surgeon in all the procedures, guarantor and designed the study; Durán M, Padial A, Anelli FM, Ayllón MD and García- Gaitán C participated in the acquisition, analysis, and interpretation of the data; Calleja-Lozano R and Durán M did the literature review; Durán M drafted the initial manuscript; Briceno J and Sánchez-Hidalgo JM revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by Comité de Ética de la Investigación de Córdoba, Hospital Universitario Reina Sofía, España.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Javier Briceño, MD, PhD, Chairman, Unit of Hepatobiliary Surgery and Liver Transplantation, General and Digestive Surgery Department, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, Cordoba 14004, Spain. javibriceno@hotmail.com
Received: March 26, 2021
Peer-review started: March 26, 2021
First decision: November 11, 2021
Revised: December 2, 2021
Accepted: December 25, 2021
Article in press: December 25, 2021
Published online: January 27, 2022
Processing time: 300 Days and 19.2 Hours
Abstract
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.

Keywords: Robotics; Hepatectomy; Minimally invasive surgery; Liver surgery; Da vinci

Core Tip: The number of liver procedures performed laparoscopically remains highly variable, ranging from 10% up to 80% in some centers, and complex hepatectomies are still confined to expert and experienced laparoscopic liver surgeons. The robotic approach is gradually being introduced in liver surgery and has increased notably in recent years, which could compensate for the inherent difficulties of the laparoscopic approach. In this study, we analyzed our single-center data of robotic liver resections using the da Vinci Xi System®.