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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...

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Autores principales: Perrakis, Aristotelis, Rahimli, Mirhasan, Gumbs, Andrew A., Negrini, Victor, Andric, Mihailo, Stockheim, Jessica, Wex, Cora, Lorenz, Eric, Arend, Joerg, Franz, Mareike, Croner, Roland S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653962/
https://www.ncbi.nlm.nih.gov/pubmed/34830547
http://dx.doi.org/10.3390/jcm10225265
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author Perrakis, Aristotelis
Rahimli, Mirhasan
Gumbs, Andrew A.
Negrini, Victor
Andric, Mihailo
Stockheim, Jessica
Wex, Cora
Lorenz, Eric
Arend, Joerg
Franz, Mareike
Croner, Roland S.
author_facet Perrakis, Aristotelis
Rahimli, Mirhasan
Gumbs, Andrew A.
Negrini, Victor
Andric, Mihailo
Stockheim, Jessica
Wex, Cora
Lorenz, Eric
Arend, Joerg
Franz, Mareike
Croner, Roland S.
author_sort Perrakis, Aristotelis
collection PubMed
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 (p < 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 (p = 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.
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spelling pubmed-86539622021-12-09 Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery Perrakis, Aristotelis Rahimli, Mirhasan Gumbs, Andrew A. Negrini, Victor Andric, Mihailo Stockheim, Jessica Wex, Cora Lorenz, Eric Arend, Joerg Franz, Mareike Croner, Roland S. J Clin Med Article 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 (p < 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 (p = 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. MDPI 2021-11-12 /pmc/articles/PMC8653962/ /pubmed/34830547 http://dx.doi.org/10.3390/jcm10225265 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Perrakis, Aristotelis
Rahimli, Mirhasan
Gumbs, Andrew A.
Negrini, Victor
Andric, Mihailo
Stockheim, Jessica
Wex, Cora
Lorenz, Eric
Arend, Joerg
Franz, Mareike
Croner, Roland S.
Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery
title 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_short 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
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8653962/
https://www.ncbi.nlm.nih.gov/pubmed/34830547
http://dx.doi.org/10.3390/jcm10225265
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