背景:当前研究的目的是提出机器人肝脏手术程序实施阶段的结果,并评估IWATE难度评分在预测机器人肝脏手术难度和术后并发症方面的有效性。
方法:基于乌尔姆大学医院跨学科机器人中心的前瞻性数据库,识别并分析了前100例机器人肝脏手术。围手术期参数(手术时间和失血量)和术后参数,包括发病率,死亡率,评估住院时间,并在不同的IWATE困难类别之间比较结果.
结果:从2020年11月到2023年1月,进行了100次机器人肝脏手术(41名女性,59名男性;平均年龄60.6岁,中位数BMI25.9kg/m2)。手术时间的中位数为180分钟(IQR:128.7),中位失血量为300ml(IQR:550)。90天死亡率为2%,总体发病率为21%,13%的患者发生主要并发症(根据Clavien/Dindo≥3级)。在3例患者中观察到临床相关的术后胆漏。术后肝功能衰竭发生率为7%(4级A,3B级)。手术持续时间(p<0.001),失血量(p<0.001),CCI(p=0.004),总发病率(p=0.004),与低级别类别相比,IWATE“专家”类别的住院时间(p<0.001)显著增加。
结论:机器人手术为肝脏手术提供了一种微创方法,具有良好的临床效果,甚至在实施阶段。在当前的研究中,IWATE难度评分能够在评估机器人肝脏手术的复杂性时预测手术难度和术后结果。因此,IWATE评分在预测这些结局方面的作用凸显了其作为手术计划和决策工具的重要性.
BACKGROUND: Aim of the current study was to present the results of the implementation phase of a robotic liver surgery program and to assess the validity of the IWATE difficulty score in predicting difficulty and postoperative complications in robotic liver surgery.
METHODS: Based on the prospective database of the Interdisciplinary Robotic Center of Ulm University Hospital, the first 100 robotic liver surgeries were identified and analyzed. Perioperative parameters (duration of surgery and blood loss) and postoperative parameters including morbidity, mortality, and length of hospital stay were assessed and the results were compared between different IWATE difficulty categories.
RESULTS: From November 2020 until January 2023, 100 robotic liver surgeries were performed (41 female, 59 male; median age 60.6 years, median BMI 25.9 kg/m2). Median duration of surgery was 180 min (IQR: 128.7), and median blood loss was 300 ml (IQR: 550). Ninety-day mortality was 2%, and overall morbidity was 21%, with major complications occurring in 13% of patients (≥ grade 3 according to Clavien/Dindo). A clinically relevant postoperative biliary leakage was observed in 3 patients. Posthepatectomy liver failure occurred in 7% (4 Grade A, 3 Grade B). Duration of surgery (p < 0.001), blood loss (p < 0.001), CCI (p = 0.004), overall morbidity (p = 0.004), and length of hospital stay (p < 0.001) were significantly increased in the IWATE \'expert\' category compared to lower categories.
CONCLUSIONS: Robotic surgery offers a minimally invasive approach for liver surgery with favorable clinical outcomes, even in the implementation phase. In the current study the IWATE difficulty score had the ability to predict both difficulty of surgery as well as postoperative outcomes when assessing the complexity of robotic liver surgery. Therefore, the role of the IWATE score in predicting these outcomes highlights its importance as a tool in surgical planning and decision-making.