Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery

Background: The implementation of robotics in liver surgery offers several advantages compared to conventional open and laparoscopic techniques. One major advantage is the enhanced degree of freedom at the tip of the robotic tools compared to laparoscopic instruments. This enables excellent vessel c...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Aristotelis Perrakis, Mirhasan Rahimli, Andrew A. Gumbs, Victor Negrini, Mihailo Andric, Jessica Stockheim, Cora Wex, Eric Lorenz, Joerg Arend, Mareike Franz, Roland S. Croner
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	robotic surgery hepatectomy liver metastasis hepatocellular carcinoma liver surgery Medicine R
Acceso en línea:	https://doaj.org/article/9b465f59fc4846b2a4cffa8d37ecddb0
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:9b465f59fc4846b2a4cffa8d37ecddb0
record_format	dspace
spelling	oai:doaj.org-article:9b465f59fc4846b2a4cffa8d37ecddb02021-11-25T18:01:05ZThree-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery10.3390/jcm102252652077-0383https://doaj.org/article/9b465f59fc4846b2a4cffa8d37ecddb02021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5265https://doaj.org/toc/2077-0383Background: The implementation of robotics in liver surgery offers several advantages compared to conventional open and laparoscopic techniques. One major advantage is the enhanced degree of freedom at the tip of the robotic tools compared to laparoscopic instruments. This enables excellent vessel control during inflow and outflow dissection of the liver. Parenchymal transection remains the most challenging part during robotic liver resection because currently available robotic instruments for parenchymal transection have several limitations and there is no standardized technique as of yet. We established a new strategy and share our experience. Methods: We present a novel technique for the transection of liver parenchyma during robotic surgery, using three devices (3D) simultaneously: monopolar scissors and bipolar Maryland forceps of the robot and laparoscopic-guided waterjet. We collected the perioperative data of twenty-eight patients who underwent this procedure for minor and major liver resections between February 2019 and December 2020 from the Magdeburg Registry of minimally invasive liver surgery (MD-MILS). Results: Twenty-eight patients underwent robotic-assisted 3D parenchyma dissection within the investigation period. Twelve cases of major and sixteen cases of minor hepatectomy for malignant and non-malignant cases were performed. Operative time for major liver resections (≥ 3 liver segments) was 381.7 (SD 80.6) min vs. 252.0 (70.4) min for minor resections (<i>p</i> < 0.01). Intraoperative measured blood loss was 495.8 (SD 508.8) ml for major and 256.3 (170.2) ml for minor liver resections (<i>p</i> = 0.090). The mean postoperative stay was 13.3 (SD 11.1) days for all cases. Liver surgery-related morbidity was 10.7%, no mortalities occurred. We achieved an R0 resection in all malignant cases. Conclusions: The 3D technique for parenchyma dissection in robotic liver surgery is a safe and feasible procedure. This novel method offers an advanced locally controlled preparation of intrahepatic vessels and bile ducts. The combination of precise extrahepatic vessel handling with the 3D technique of parenchyma dissection is a fundamental step forward to the standardization of robotic liver surgery for teaching purposing and the wider adoption of robotic hepatectomy into routine patient care.Aristotelis PerrakisMirhasan RahimliAndrew A. GumbsVictor NegriniMihailo AndricJessica StockheimCora WexEric LorenzJoerg ArendMareike FranzRoland S. CronerMDPI AGarticlerobotic surgeryhepatectomyliver metastasishepatocellular carcinomaliver surgeryMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5265, p 5265 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	robotic surgery hepatectomy liver metastasis hepatocellular carcinoma liver surgery Medicine R
spellingShingle	robotic surgery hepatectomy liver metastasis hepatocellular carcinoma liver surgery Medicine R Aristotelis Perrakis Mirhasan Rahimli Andrew A. Gumbs Victor Negrini Mihailo Andric Jessica Stockheim Cora Wex Eric Lorenz Joerg Arend Mareike Franz Roland S. Croner Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery
description	Background: The implementation of robotics in liver surgery offers several advantages compared to conventional open and laparoscopic techniques. One major advantage is the enhanced degree of freedom at the tip of the robotic tools compared to laparoscopic instruments. This enables excellent vessel control during inflow and outflow dissection of the liver. Parenchymal transection remains the most challenging part during robotic liver resection because currently available robotic instruments for parenchymal transection have several limitations and there is no standardized technique as of yet. We established a new strategy and share our experience. Methods: We present a novel technique for the transection of liver parenchyma during robotic surgery, using three devices (3D) simultaneously: monopolar scissors and bipolar Maryland forceps of the robot and laparoscopic-guided waterjet. We collected the perioperative data of twenty-eight patients who underwent this procedure for minor and major liver resections between February 2019 and December 2020 from the Magdeburg Registry of minimally invasive liver surgery (MD-MILS). Results: Twenty-eight patients underwent robotic-assisted 3D parenchyma dissection within the investigation period. Twelve cases of major and sixteen cases of minor hepatectomy for malignant and non-malignant cases were performed. Operative time for major liver resections (≥ 3 liver segments) was 381.7 (SD 80.6) min vs. 252.0 (70.4) min for minor resections (<i>p</i> < 0.01). Intraoperative measured blood loss was 495.8 (SD 508.8) ml for major and 256.3 (170.2) ml for minor liver resections (<i>p</i> = 0.090). The mean postoperative stay was 13.3 (SD 11.1) days for all cases. Liver surgery-related morbidity was 10.7%, no mortalities occurred. We achieved an R0 resection in all malignant cases. Conclusions: The 3D technique for parenchyma dissection in robotic liver surgery is a safe and feasible procedure. This novel method offers an advanced locally controlled preparation of intrahepatic vessels and bile ducts. The combination of precise extrahepatic vessel handling with the 3D technique of parenchyma dissection is a fundamental step forward to the standardization of robotic liver surgery for teaching purposing and the wider adoption of robotic hepatectomy into routine patient care.
format	article
author	Aristotelis Perrakis Mirhasan Rahimli Andrew A. Gumbs Victor Negrini Mihailo Andric Jessica Stockheim Cora Wex Eric Lorenz Joerg Arend Mareike Franz Roland S. Croner
author_facet	Aristotelis Perrakis Mirhasan Rahimli Andrew A. Gumbs Victor Negrini Mihailo Andric Jessica Stockheim Cora Wex Eric Lorenz Joerg Arend Mareike Franz Roland S. Croner
author_sort	Aristotelis Perrakis
title	Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery
title_short	Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery
title_full	Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery
title_fullStr	Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery
title_full_unstemmed	Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery
title_sort	three-device (3d) technique for liver parenchyma dissection in robotic liver surgery
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/9b465f59fc4846b2a4cffa8d37ecddb0
work_keys_str_mv	AT aristotelisperrakis threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT mirhasanrahimli threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT andrewagumbs threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT victornegrini threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT mihailoandric threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT jessicastockheim threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT corawex threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT ericlorenz threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT joergarend threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT mareikefranz threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery AT rolandscroner threedevice3dtechniqueforliverparenchymadissectioninroboticliversurgery
_version_	1718411761907924992

Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery

Ejemplares similares