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Robotic hepatic parenchymal transection: a two-surgeon technique using ultrasonic dissection and irrigated bipolar coagulation

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Abstract

Liver transection is the most challenging part of hepatectomy due to the risk of hemorrhage which is associated with postoperative morbidity and mortality and reduced long-term survival. Parenchymal ultrasonic dissection (UD) with bipolar coagulation (BPC) has been widely recognized as a safe, effective, and standard technique during open and laparoscopic hepatectomy. We here introduce our technique of robotic liver transection using UD with BPC and report on short-term perioperative outcomes. From a single-institution prospective liver surgery database, we identified patients who underwent robotic liver resection. Demographic, anesthetic, perioperative, and oncologic data were analyzed. Fifty patients underwent robotic liver resection using UD and BPC for liver malignancies (n = 42) and benign lesions (n = 8). The median age of the patients was 67 years and 28 were male. According to the difficulty scoring system, 60% (n = 30) of liver resection were considered difficult. Three cases (6%) were converted to open surgery. The median operative time was 240 min, and the median estimated blood loss was 200 ml; 2 patients required operative transfusions. The overall complication rate was 38% (grade I, 29; grade II, 15; grade III, 3; grade IV, 1). Seven patients (14%) experienced biliary leakage. The median length of hospital stay post-surgery was 7 (range 3–20) days. The R0 resection rate was 92%. Robotic parenchymal transection using UD and irrigated BPC appears a simple, safe, and effective technique. However, our results must be confirmed in larger series or in randomized controlled trials.

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Authors and Affiliations

  1. Department of Digestive Surgery Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France

    Antoine Camerlo, Cloé Magallon, Charles Vanbrugghe, Yves Rinaldi & Régis Fara

  2. Department of Clinical Research Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France

    Laurent Chiche

  3. Department of Radiology Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France

    Chloé Gaudon

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  1. Antoine Camerlo
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Correspondence to Antoine Camerlo.

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Antoine Camerlo, Cloé Magallon, Charles Vanbrugghe, Laurent Chiche, Chloé Gaudon, Yves Rinaldi and Régis Fara declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Camerlo, A., Magallon, C., Vanbrugghe, C. et al. Robotic hepatic parenchymal transection: a two-surgeon technique using ultrasonic dissection and irrigated bipolar coagulation. J Robotic Surg 15, 539–546 (2021). https://doi.org/10.1007/s11701-020-01138-8

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