Open, Laparoscopic and Robotic Hepatic Transection: Tools and Methods

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A case-control study conducted by Lee et al. In another study conducted in , Zhang et al. The procedure was successful in all patients, without conversion to open procedures, and only four required blood transfusions. Fonseca et al. Blood transfusion was required in There was no operative mortality in both studies.

The rate of postoperative complications was It is clear, therefore, that there has been an advance in the art of laparoscopic hepatectomy, as the percentage of complications and the volume of blood loss have been decreasing. Alhomaidhi et al. On average, it took 65 min less to perform the laparoscopic surgery. Blood loss volume was ml in patients undergoing laparoscopic hepatectomy, while the loss at laparotomy was of ml on average. Postoperative morbidity was relatively low on both operations.

The length of stay and mortality were also reduced. Franken et al. They noted that the estimated blood loss average was lower in patients undergoing laparoscopy ml than in those undergoing open surgery ml. The average hospital stay was five days in group 1 and six days in group 2. Although blood loss decreased with laparoscopic hepatectomy, the need for blood transfusion was not significantly different and the severity of complications was not different between the groups. Koffron et al. They noted that the laparoscopic approach was superior to the open technique.

Minimally Invasive Techniques and Outcomes in Hepatic Resection | Oncohema Key

The benefits were significant in the following aspects: duration of surgery 99 vs. Wakabayashi et al. It was noticed that the exposure of the region is better, the hospital stay is shorter, the size of the incision and the blood loss was smaller, and the cost to the hospital is lower. Despite all these advantages, it was elucidated by Wakabayashi et al.

Robotic Liver Surgery

Wang et al. According to Machado et al. The use of hand assisted techniques makes it easier to display the liver, to section the parenchyma, especially in cirrhotic livers, and also allows the surgeon the tactile sensation lost in laparoscopy. However, it is believed that a frequent use of this technique is not required, as it should be a step prior to complete conversion to laparotomy, or an option when difficulties for the realization of a total laparoscopic technique are expected.

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The literature review shows an exponential growth in the number of and indications for laparoscopic hepatectomies. In a review of all published cases of laparoscopic hepatectomies, held in , in which cases were identified, the mortality rate was only 0.

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Thus, from the perspective of Pais-Costa et al. Therefore, if there is indication for a hepatectomy, provided there is no contraindication for the method intestinal obstruction, generalized peritonitis, severe cardiopulmonary disease, or severe hypovolemic shock among others reasons , laparoscopy should be the technique of choice When comparing laparoscopic and robotic techniques, in accordance with Montalti et al. Studies show that there is no significant difference in morbidity rate between the two techniques, although it was observed a tendency for fewer complications in the robotic group.

In a systematic review and meta-analysis, Montalti et al.

Early Experience From a Single Surgical Center

Furthermore, the increased dexterity activated by the endowristed movements, the filter software for the surgeon movements, and the high definition 3-D vision provided by a stereoscopic camera allows a constant and careful dissection of structures. All of this leads to minimal biliary leakage and overall reduction in postoperative complications Despite all these advantages, robotic assisted hepatectomy has evolved slowly over the years and it is currently unable to provide useful tools to fully exploit the potential of the movements and the vision offered by the robot, especially when the resection space is limited.

Outcomes of hepatopancreatic robotic surgery: Update from the literature - Hepatic surgery.

It is important to note that to perform the robotic technique, an additional surgeon responsible for the procedure is required and the costs with the robot, the instrumentation, and the annual maintenance are high. In addition, there are few centers in the world that perform robotic liver resections and they always go through a thorough patient selection, which limits the number of procedures performed, and keeps it as non-standard, even if these centers can surpass the learning curve.

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The results of the meta-analysis made by Montalti et al. The most used technique for laporoscopic hepatic transection requires the use of a harmonic scalpel for superficial liver trasection and Cavitron Ultasonic Surgical Aspirator for deeper cuts, to provide a more meticulous and precise parenchymal structure dissection. Another important factor regards the operation time, which was significantly higher in robotic hepatectomy. This may be due to the technique itself buy may also be a result of robotics being new and requiring, therefore, greater experience and refinement.

As it is known, one of the principles of oncologic resection of malignant tumors is the maintenance of free margin to avoid incomplete resection of the tumor and possible iatrogenic spread. That is why the previously mentioned meta-analysis aimed to observe the margins width in each technique. As a result, no significant difference was observed, although there was a tendency for smaller margins in laparoscopic hepatectomies, which suggests a greater difficulty in identifying the lesion through robotic intraoperative ultrasound.

This can be explained by the fact that the surgeon who performs the ultrasound is not the one responsible for the robotic hepatectomy. However, further studies are necessary for a better data analysis.

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The study of Montalti et al. Thus, it is not clear whether robotic assistance demonstrates substantial advantage over laparoscopic techniques since both approaches are considered minimally invasive, with no differences in safety or efficacy The approach of liver tumors is considered complex as it involves factors related to the clinical condition of the patient, the function of the liver, and the stage and characteristics of malignant diseases. Some tumors develop in livers considered normal, while others arise in organs compromised by obstruction of the biliary tract or liver diseases such as steatosis, fibrosis, or cirrhosis.

Each of these factors can influence the result of surgeries and, therefore, careful attention to all of these aspects must be paid in order to achieve good results. The laparoscopic approach is more beneficial when compared to the open technique, despite the barriers and mistrust that still remains. Laparoscopy has shorter procedure duration, shorter hospital stay, and lower incidence of complications. Furthermore, the local malignant recurrence rate is also reduced in the closed surgical procedure. When laparoscopic and robotic techniques are compared, it is clear that the robotic assistance can overcome many limitations that laparoscopic surgery presents.

It is not yet clear whether robotic assistance is an advantage over laparoscopy, since hospital stay, morbidity, and estimated blood loss are similar. Financial source: none. National Center for Biotechnology Information , U.

Arq Bras Cir Dig. Author information Article notes Copyright and License information Disclaimer. Received Oct 13; Accepted Dec Copyright notice. This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article has been cited by other articles in PMC. ABSTRACT Introduction: Several factors have made hepatectomy an increasingly safe surgery and new drugs allowed surgical treatment for patients who initially were not candidates for resection.

Aim: Compare the surgical techniques in open, laparoscopic, and robotic assisted hepatectomy for resection of liver tumors. Results: The comparative study shows the benefits of laparoscopic surgery over open surgery, such as smaller incisions, less postoperative pain, shorter recovery time, smaller immune and metabolic response, and quicker restoration of oral ingestion as well as lower morbidity rates. Conclusion: Despite all challenges, laparoscopic hepatectomy presents many benefits over open surgery. METHODS This literature review is based on scientific papers published regarding the indications for open, laparoscopic, and robotic assisted hepatectomy in resection of liver tumors and on papers comparing these techniques.

RESULTS Patient preparation A correct preoperative prepare must take into account the nature of the liver disease, its severity, and the type of operation to be performed Open in a separate window. Laparoscopic hepatic resection The technical advances in laparoscopy have revolutionized surgical treatment for many diseases.

Robotic hepatic resection Robotics was introduced in medicine nearly two decades ago as a way of overcoming the limitations of movement of the laparoscopic instruments and providing better visualization of the surgical field. The specimen is then obtained through a Pfannenstiel incision inside a bag called endobag 17 Robotic technique can also occur with fluorescence guidance through application of indocyanine green that can be injected into the bloodstream and becomes fluorescent once it gets in contact with light of a specific wavelength near the infrared spectrum around nm or a laser beam.

Comparison of techniques Among laparoscopic surgeries, hepatectomies were one of the last to be carried out.