Introduction: Laparoscopic liver resection (LLR) is worldwide accepted as safe treatment option for anterior lesions of the liver. The approach of lesions located in the postero-superior (PS) segments (I-IVa-VII-VIII) is more difficult and usually associated to a higher conversion rate and intraoperative complications. It has been speculated that robotic assistance can facilitate the approach to these segments. Method: From 2005 to 2013, 122 minor liver resection were performed in PS segments: 91 of whom with pure laparoscopic approach (LAP-Group) and 31 with robotic assistance (ROB-Group). We analyzed retrospectively data coming from a prospective kept database looking to pre-intra and postoperative parameters in both groups. Results: No perioperative mortality was recorded. Mean age was of 58.6 15.6 vs. 63.7 12.7 years, respectively (p = 0.12), male rate was 54.9% vs. 61.3% (p = 0.68). Contemporaneous colic resection was performed in 4.4 vs. 22.6% (p = 0.006). Type of resection were: bisegmentectomy in 19% and 16%; monosegmentectomy 24% and 16%; wedge 37% and 42%; mixed 20% and 26%, respectively for Lap and ROB (p = 0.8). Previous liver resection were 11% vs. 7.4% (p = 0.73), mean surgical time 286 103 vs. 301 135 minutes (p = 0.54), blood loss 292 404 vs. 380 381 cc (p = 0.35) respectively. Pringle maneuver was 13.2% vs. 58.1% respectively for LAP and ROB (p < 0.01). Conversion rate was 11% vs. 16.1% (0.53). Histology revealed that the mean nodules number was of 1.6 0.9 vs. 1.9 1.3 (p = 0.2), total lesions dimension was of 44.4 28.2 vs. 42.9 31.1 mm (p = 0.8) and R1 margins 15% vs. 11% (p = 0.55). Overall complication rate was of 18.2 vs. 14.8% (p = 0.6), mean hospital stay 5.6 4.1 vs. 8.6 8 days (p = 0.01). Conclusions: Pure laparoscopic and robotic liver resections for lesions located in PS segments have a similar outcome and conversion rate. A trend for higher blood losses could be related to differences in operative techniques and resection devices (surgical aspirator in LAP vs. crush clamping technique in ROB).
Laparoscopic vs robotic minor liver resection of lesions located in the postero-superior segments: A comparative analysis / Montalti, Roberto; Patriti, Alberto; Scuderi, Vincenzo; Vanlander, Aude; Troisi, Roberto. - (2014). (Intervento presentato al convegno 11th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA World Congress 2014) tenutosi a Seoul, Korea nel March 22-27, 2014).
Laparoscopic vs robotic minor liver resection of lesions located in the postero-superior segments: A comparative analysis
Roberto Montalti
;Roberto Troisi
2014
Abstract
Introduction: Laparoscopic liver resection (LLR) is worldwide accepted as safe treatment option for anterior lesions of the liver. The approach of lesions located in the postero-superior (PS) segments (I-IVa-VII-VIII) is more difficult and usually associated to a higher conversion rate and intraoperative complications. It has been speculated that robotic assistance can facilitate the approach to these segments. Method: From 2005 to 2013, 122 minor liver resection were performed in PS segments: 91 of whom with pure laparoscopic approach (LAP-Group) and 31 with robotic assistance (ROB-Group). We analyzed retrospectively data coming from a prospective kept database looking to pre-intra and postoperative parameters in both groups. Results: No perioperative mortality was recorded. Mean age was of 58.6 15.6 vs. 63.7 12.7 years, respectively (p = 0.12), male rate was 54.9% vs. 61.3% (p = 0.68). Contemporaneous colic resection was performed in 4.4 vs. 22.6% (p = 0.006). Type of resection were: bisegmentectomy in 19% and 16%; monosegmentectomy 24% and 16%; wedge 37% and 42%; mixed 20% and 26%, respectively for Lap and ROB (p = 0.8). Previous liver resection were 11% vs. 7.4% (p = 0.73), mean surgical time 286 103 vs. 301 135 minutes (p = 0.54), blood loss 292 404 vs. 380 381 cc (p = 0.35) respectively. Pringle maneuver was 13.2% vs. 58.1% respectively for LAP and ROB (p < 0.01). Conversion rate was 11% vs. 16.1% (0.53). Histology revealed that the mean nodules number was of 1.6 0.9 vs. 1.9 1.3 (p = 0.2), total lesions dimension was of 44.4 28.2 vs. 42.9 31.1 mm (p = 0.8) and R1 margins 15% vs. 11% (p = 0.55). Overall complication rate was of 18.2 vs. 14.8% (p = 0.6), mean hospital stay 5.6 4.1 vs. 8.6 8 days (p = 0.01). Conclusions: Pure laparoscopic and robotic liver resections for lesions located in PS segments have a similar outcome and conversion rate. A trend for higher blood losses could be related to differences in operative techniques and resection devices (surgical aspirator in LAP vs. crush clamping technique in ROB).I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
