Robotic-assisted right posterior segmentectomies for liver lesions: single-center experience of an evolutional method in left semi-lateral position
Journal
Journal of robotic surgery
Journal Volume
13
Journal Issue
2
Pages
231
Date Issued
2019-04
Abstract
Despite the popularity of minimally invasive surgery (MIS) for hepatectomy, limitations in the approach of the right posterior section of the liver remain. Although skills and approach techniques have been developed for hepatectomy of lesions in the posterior segments of the liver, most are performed laparoscopically and are limited to few experienced hands using rigid laparoscopic instruments. In this study, we tried a different approach area via the aid of a flexible robotic system. Since 2012, we have successfully completed more than 200 robotic hepatectomy procedures in our institution. Two different patient settings have been applied for right posterior segment lesions, including supine position as general setting in early cases and left semi-lateral decubitus setting in our later cases. The demographic data and perioperative outcomes between the two groups were analyzed in regard to different positioning. A total of 25 patients with right posterior segment lesions underwent robotic-assisted resection, 13 were placed in supine position and 12 in left semi-lateral position. The left semi-lateral group had significantly shorter operation time (306.0 versus 416.8 min, p = 0.023), less blood loss (203.9 versus 1092.3 mL, p = 0.030), and lower transfusion rates (0 versus 46.2%, p = 0.015). We described an evolutionary technique for robotic right posterior segmentectomies with the patient placed in left semi-lateral position. This method can be applied for most patients easily and is demonstrated as a safe and feasible approach in selected patients owing to its ability to overcome the difficulty of MIS hepatectomy for right posterior lesions.
Subjects
Left semi-lateral position; Minimally invasive surgery; Right posterior segment; Robotic hepatectomy
Other Subjects
alanine aminotransferase; aspartate aminotransferase; hepatitis B surface antigen; adult; albumin level; Article; bile duct carcinoma; biloma; bleeding; blood transfusion; body mass; body position; cauterization; Child Pugh score; clinical article; clinical outcome; colorectal liver metastasis; controlled study; demography; female; gravity; Hepatitis B virus; Hepatitis C virus; histology; hospitalization; human; human tissue; left semi lateral position; liver cell carcinoma; liver cirrhosis; liver injury; liver mobilization; liver parenchyma; liver resection; male; middle aged; minimally invasive surgery; operation duration; operative blood loss; platelet count; postoperative hemorrhage; retroperitoneum; robotic assisted right posterior segmentectomy; segmentectomy; supine position; surgical mortality; surgical technique; tumor volume
Publisher
SPRINGER LONDON LTD
Type
journal article