Pioneering Robotic Liver Surgery in Germany: First Experiences with Liver Malignancies
Identifieur interne : 000661 ( Main/Merge ); précédent : 000660; suivant : 000662Pioneering Robotic Liver Surgery in Germany: First Experiences with Liver Malignancies
Auteurs : Roland S. Croner [Allemagne] ; Aristotelis Perrakis [Allemagne] ; Maximillian Brunner [Allemagne] ; Klaus E. Matzel [Allemagne] ; Werner Hohenberger [Allemagne]Source :
- Frontiers in Surgery [ 2296-875X ] ; 2015.
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.
Url:
DOI: 10.3389/fsurg.2015.00018
PubMed: 26052515
PubMed Central: 4440394
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Croner</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Surgery and Liver Center, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Perrakis, Aristotelis" sort="Perrakis, Aristotelis" uniqKey="Perrakis A" first="Aristotelis" last="Perrakis">Aristotelis Perrakis</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Surgery and Liver Center, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Brunner, Maximillian" sort="Brunner, Maximillian" uniqKey="Brunner M" first="Maximillian" last="Brunner">Maximillian Brunner</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Surgery and Liver Center, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Matzel, Klaus E" sort="Matzel, Klaus E" uniqKey="Matzel K" first="Klaus E." last="Matzel">Klaus E. 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Croner</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Surgery and Liver Center, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Perrakis, Aristotelis" sort="Perrakis, Aristotelis" uniqKey="Perrakis A" first="Aristotelis" last="Perrakis">Aristotelis Perrakis</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Surgery and Liver Center, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Brunner, Maximillian" sort="Brunner, Maximillian" uniqKey="Brunner M" first="Maximillian" last="Brunner">Maximillian Brunner</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Surgery and Liver Center, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Matzel, Klaus E" sort="Matzel, Klaus E" uniqKey="Matzel K" first="Klaus E." last="Matzel">Klaus E. Matzel</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Surgery and Liver Center, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Hohenberger, Werner" sort="Hohenberger, Werner" uniqKey="Hohenberger W" first="Werner" last="Hohenberger">Werner Hohenberger</name><affiliation wicri:level="1"><nlm:aff id="aff1"><institution>Department of Surgery and Liver Center, University Hospital Erlangen</institution>,<addr-line>Erlangen</addr-line>,<country>Germany</country></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">Frontiers in Surgery</title><idno type="eISSN">2296-875X</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="ST1"><title>Background</title><p>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.</p></sec><sec id="ST2"><title>Material and methods</title><p>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.</p></sec><sec id="ST3"><title>Results</title><p>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.</p></sec><sec id="ST4"><title>Conclusion</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Croome, Kp" uniqKey="Croome K">KP Croome</name></author><author><name sortKey="Yamashita, Mh" uniqKey="Yamashita M">MH Yamashita</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Reddy, Sk" uniqKey="Reddy S">SK Reddy</name></author><author><name sortKey="Tsung, A" uniqKey="Tsung A">A Tsung</name></author><author><name sortKey="Geller, Da" uniqKey="Geller D">DA Geller</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Buell, Jf" uniqKey="Buell J">JF Buell</name></author><author><name sortKey="Cherqui, D" uniqKey="Cherqui D">D Cherqui</name></author><author><name sortKey="Geller, Da" uniqKey="Geller D">DA Geller</name></author><author><name sortKey="O Ourke, N" uniqKey="O Ourke N">N O’Rourke</name></author><author><name sortKey="Iannitti, D" uniqKey="Iannitti D">D Iannitti</name></author><author><name sortKey="Dagher, I" uniqKey="Dagher I">I Dagher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ishizawa, T" uniqKey="Ishizawa T">T Ishizawa</name></author><author><name sortKey="Gumbs, Aa" uniqKey="Gumbs A">AA Gumbs</name></author><author><name sortKey="Kokudo, N" uniqKey="Kokudo N">N Kokudo</name></author><author><name sortKey="Gayet, B" uniqKey="Gayet B">B Gayet</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Milone, L" uniqKey="Milone L">L Milone</name></author><author><name sortKey="Daskalaki, D" uniqKey="Daskalaki D">D Daskalaki</name></author><author><name sortKey="Fernandes, E" uniqKey="Fernandes E">E Fernandes</name></author><author><name sortKey="Damoli, I" uniqKey="Damoli I">I Damoli</name></author><author><name sortKey="Giulianotti, Pc" uniqKey="Giulianotti P">PC Giulianotti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hibi, T" uniqKey="Hibi T">T Hibi</name></author><author><name sortKey="Cherqui, D" uniqKey="Cherqui D">D Cherqui</name></author><author><name sortKey="Geller, Da" uniqKey="Geller D">DA Geller</name></author><author><name sortKey="Itano, O" uniqKey="Itano O">O Itano</name></author><author><name sortKey="Kitagawa, Y" uniqKey="Kitagawa Y">Y Kitagawa</name></author><author><name sortKey="Wakabayashi, G" uniqKey="Wakabayashi G">G Wakabayashi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cherqui, D" uniqKey="Cherqui D">D Cherqui</name></author><author><name sortKey="Laurent, A" uniqKey="Laurent A">A Laurent</name></author><author><name sortKey="Tayar, C" uniqKey="Tayar C">C Tayar</name></author><author><name sortKey="Chang, S" uniqKey="Chang S">S Chang</name></author><author><name sortKey="Van Nhieu, Jt" uniqKey="Van Nhieu J">JT Van Nhieu</name></author><author><name sortKey="Loriau, J" uniqKey="Loriau J">J Loriau</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tsung, A" uniqKey="Tsung A">A Tsung</name></author><author><name sortKey="Geller, Da" uniqKey="Geller D">DA Geller</name></author><author><name sortKey="Sukato, Dc" uniqKey="Sukato D">DC Sukato</name></author><author><name sortKey="Sabbaghian, S" uniqKey="Sabbaghian S">S Sabbaghian</name></author><author><name sortKey="Tohme, S" uniqKey="Tohme S">S Tohme</name></author><author><name sortKey="Steel, J" uniqKey="Steel J">J Steel</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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