Abstract
Minimally invasive liver surgery is growing worldwide with obvious benefits for the treated patients. These procedures maybe improved by robotic techniques, which add several innovative features. In Germany, we were the first surgical department implementing robotic assisted minimally invasive liver resections. Between June 2013 and March 2015, we performed robotic based minimally invasive liver resections in nine patients with malignant liver disease. Five off these patients suffered from primary and four from secondary liver malignancies. We retrospectively analyzed the perioperative variables of these patients and the oncological follow up. Mean age of the patients was 63 years (range 45-71). One patient suffered from intrahepatic cholangiocellular, four from hepatocellular carcinoma, and four patients from colorectal liver metastases. In six patients, left lateral liver resection, in two cases single segment resection, and in one case minimally invasive guided liver ablation were performed. Five patients underwent previous abdominal surgery. Mean operation time was 312 min (range 115-458 min). Mean weight of the liver specimens was 182 g (range 62-260 g) and mean estimated blood loss was 251 ml (range 10-650 ml). The mean tumor size was 4.4 cm (range 3.5-5.5 cm). In all cases, R0 status was confirmed with a mean margin of 0.6 cm (range 0.1-1.5 cm). One patient developed small bowel fistula on postoperative day 5, which could be treated conservatively. No patient died. Mean hospital stay of the patients was 6 days (range 3-10 days). During a mean follow up of 12 months (range 1-21 months), two patients developed tumor recurrence. Robotic-based liver surgery is feasible in patients with primary and secondary liver malignancies. To achieve perioperative parameters comparable to open settings, the learning curve must be passed. Minor liver resections are good candidates to start this technique. But the huge benefits of robotic-based liver resections should be expected in extended procedures beyond minor liver resections with the currently available technology.
Highlights
Liver parenchymal disorders like steatosis or fibrosis are no limitations for this technique but correlate with increased operation time
Even adhesions after prior surgery are no contraindications for robotic-based procedures
In case of expected relevant adhesions, the situation can be clarified by explorative laparoscopy via a 5-mm trocar in the left upper abdomen after inducing the pneumoperitoneum
Summary
Invasive liver surgery is growing worldwide. Initially recommended for smaller benign lesions only, recent metaanalysis demonstrates the value for malignant tumors as well. Even liver surgery was already performed by robotics, which may add several benefits to improve standard laparoscopic operations. A recent international survey on technical aspects of liver surgery showed that Germany is worldwide behind in the performance of minimally invasive liver resections programs [6]. We picked up this issue and started as the first center in Germany minimally invasive roboticbased liver resections. Invasive liver surgery is growing worldwide with obvious benefits for the treated patients. These procedures maybe improved by robotic techniques, which add several innovative features.
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