PDF(Pubmed)
Abstract：
BACKGROUND: Liver surgery is associated with a significant hospital stay regardless the type of liver resection. A large incision is essential for open liver surgery which is a major factor in the course of the patient\'s recovery. For patients with small parenchyma liver lesions requiring surgical resection, robotic surgery potentially offers the opportunity to transform the patient\'s post-operative course. A day-case robotic liver resection pathway was formulated and implemented at our institution when patients were planned for discharge within 24 h of admission for liver surgery.
METHODS: Single surgeon case series of cases performed at a tertiary hepatobiliary and pancreatic centre between September 2022 and November 2023. The inclusion criteria were non-anatomical wedge resections, < 2 anatomical segmental resections, left lateral hepatectomy and minimally invasive surgery.
RESULTS: This is the first series of robotic day-case minor liver resection in the United Kingdom. 20 patients were included in this case series. The mean operative time was 86.6 ± 30.9 min and mean console time was 58.6 ± 24.5 min. Thirteen patients (65%) were discharged within 24 h of surgery. The main cause of hospitalisation beyond 24 h was inadequate pain relief. There were no Clavien-Dindo grade III or above complications, no 30-day readmission and 90-day mortalities.
CONCLUSIONS: This case series demonstrates that robotic day-case liver resection is safe and feasible. Robust follow-up pathways must be in place to allow for the safe implementation of this approach, to monitor for any complications and to allow intervention as required in a timely manner.
METHODS: Single surgeon case series of cases performed at a tertiary hepatobiliary and pancreatic centre between September 2022 and November 2023. The inclusion criteria were non-anatomical wedge resections, < 2 anatomical segmental resections, left lateral hepatectomy and minimally invasive surgery.
RESULTS: This is the first series of robotic day-case minor liver resection in the United Kingdom. 20 patients were included in this case series. The mean operative time was 86.6 ± 30.9 min and mean console time was 58.6 ± 24.5 min. Thirteen patients (65%) were discharged within 24 h of surgery. The main cause of hospitalisation beyond 24 h was inadequate pain relief. There were no Clavien-Dindo grade III or above complications, no 30-day readmission and 90-day mortalities.
CONCLUSIONS: This case series demonstrates that robotic day-case liver resection is safe and feasible. Robust follow-up pathways must be in place to allow for the safe implementation of this approach, to monitor for any complications and to allow intervention as required in a timely manner.
摘要：
背景：无论何种类型的肝切除，肝手术都与大量的住院时间相关。大切口对于开放肝脏手术是必不可少的，这是患者康复过程中的主要因素。对于需要手术切除的肝实质小病变患者，机器人手术可能提供机会来改变病人的术后过程。当患者计划在入院后24小时内进行肝脏手术时，我们机构制定并实施了日间机器人肝脏切除途径。
方法：2022年9月至2023年11月在三级肝胆和胰腺中心进行的单外科医生病例系列病例。纳入标准是非解剖楔形切除术，<2个解剖节段切除，左外肝切除术和微创手术。
结果：这是英国第一系列机器人日间小型肝切除术。该病例系列包括20名患者。平均手术时间为86.6±30.9分钟，平均控制台时间为58.6±24.5分钟。13例（65％）在手术后24小时内出院。住院超过24小时的主要原因是疼痛缓解不足。没有Clavien-DindoIII级或以上并发症，没有30天的再入院和90天的死亡率。
结论：本病例系列证明机器人日常肝切除是安全可行的。必须有健全的后续途径，以便安全实施这种方法，监测任何并发症，并根据需要及时进行干预。
方法：2022年9月至2023年11月在三级肝胆和胰腺中心进行的单外科医生病例系列病例。纳入标准是非解剖楔形切除术，<2个解剖节段切除，左外肝切除术和微创手术。
结果：这是英国第一系列机器人日间小型肝切除术。该病例系列包括20名患者。平均手术时间为86.6±30.9分钟，平均控制台时间为58.6±24.5分钟。13例（65％）在手术后24小时内出院。住院超过24小时的主要原因是疼痛缓解不足。没有Clavien-DindoIII级或以上并发症，没有30天的再入院和90天的死亡率。
结论：本病例系列证明机器人日常肝切除是安全可行的。必须有健全的后续途径，以便安全实施这种方法，监测任何并发症，并根据需要及时进行干预。
