Minimally Invasive Liver Resection：from Laparoscopic to Robotic_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Shulin , SHEN Baiyong , DENG Xiaxing , ZHAN Xi , HAN Bo , LIU Qin , WEN Chenlei , PENG Chenghong , LI Hongwei

Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai Institute of Digestive Surgery, Shanghai 200025, China;

Corresponding author：

Keywords：

Liver resection; Robotic liver resection; Laparoscopic resection; Hand-assisted laparoscope; Minimally invasive surgery

Video：

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Objective ?To approach feasibility, safety, and the application range of pure laparoscopic resection （PLR）, hand-assisted laparoscopic resection （HALR）, and robotic liver resection （RLR） in the minimally invasive liver resection （MILR）.
Methods ?The clinical data of 128 patients underwent MILR in the Surgical Department of the Shanghai Ruijin Hospital from September 2004 to January 2012 were analyzed retrospectively. According to the different methods, the patients were divided into PLR group, HALR group, and RLR group. The intraoperative findings and postoperative recovery of patients in three groups were compared.?
Results ?There were 82 cases in PLR group, 3 cases of which were transferred to open surgery；the mean operating time was （145.4±54.4） minutes （range：40-290 minutes）；the mean blood loss was （249.3±255.7） ml （range：30-1 500 ml）；abdominal infection was found in 3 cases and biliary fistula in 5 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （7.1±3.8） days （range：2-34 days）. There were 35 cases in HALR group, 3 cases of which were transferred to open surgery；the mean operating time was （182.7±59.2） minutes （range：60-300 minutes）；the mean blood loss was （754.3±785.2） ml （range：50-3 000 ml）；abdominal infection was found in 1 case, biliary fistula in 2 cases, and operative incision infection in 2 cases after operation, but all recovered after conservative treatment；the mean length of hospital stay was （15.4±3.7） days （range：12-30 days）. There were 11 cases in RLR group, 2 cases of which were transferred to open surgery； the mean operating time was （129.5±33.5） minutes （range：120-200 minutes）； the mean blood loss was （424.5±657.5） ml （range：50-5 000 ml）； abdominal infection was found in 1 case and biliary fistula in 1 case after operation, but all recovered after conservative treatment； the mean length of hospital stay was （6.4±1.6） days （range：5-9 days）. The operating time （P=0.001） and length of hospital stay （P=0.000） of the RLR group were shortest and the blood loss （P=0.000） of the PLR group was least among three groups.
Conclusions ?Minimally invasive resection is a safe and feasible. Different surgical procedures should be chosen according to different cases. The robotic liver resection provides new development for treatment of liver tumor.

Citation： ZHAO Shulin,SHEN Baiyong,DENG Xiaxing,ZHAN Xi,HAN Bo,LIU Qin,WEN Chenlei,PENG Chenghong,LI Hongwei,.. Minimally Invasive Liver Resection：from Laparoscopic to Robotic. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(7): 697-703. doi: Copy

1.	Reich H， McGlynn F， DeCaprio J， et al. Laparoscopic excision of benign liver lesions [J]. Obstet Gynecol， 1991， 78(5 Pt 2)：956-958.
2.	Rau HG， Meyer G， Cohnert TU， et al. Laparoscopic liver resection with the water-jet dissector [J]. Surg Endosc， 1995， 9(9)：1009-1012.
3.	Hashizume M， Takenaka K， Yanaga K， et al. Laparoscopic hepatic resection for hepatocellular carcinoma [J]. Surg Endosc，1995， 9(12)：1289-1291.
4.	Kaneko H， Takagi S， Shiba T. Laparoscopic partial hepatectomy and left lateral segmentectomy：technique and results of a clinical series [J]. Surgery， 1996， 120(3)：468-475.
5.	Samama G， Chiche L， Bréfort JL， et al. Laparoscopic anatomical hepatic resection. Report of four left lobectomies for solid tumors [J]. Surg Endosc， 1998， 12(1)：76-78.
6.	Yamanaka N， Tanaka T， Tanaka W， et al. Laparoscopic partial hepatectomy [J]. Hepatogastroenterology， 1998， 45(19)：29-33.
7.	Rau HG， Buttler E， Meyer G， et al. Laparoscopic liver resection compared with conventional partial hepatectomy—— a prospective analysis [J]. Hepatogastroenterology， 1998， 45(24)：2333-2338.
8.	Asahara T， Dohi K， Nakahara H， et al. Laparoscopy-assisted hepatectomy for a large tumor of the liver [J]. Hiroshima J Med Sci， 1998， 47(4)：163-166.
9.	Cuschieri A. Laparoscopic hand-assisted surgery for hepatic and pancreatic disease [J]. Surg Endosc， 2000， 14(11)：991-996.
10.	Giulianotti PC， Coratti A， Angelini M， et al. Robotics in general surgery：personal experience in a large community hospital [J].Arch Surg，2003，138(7)：777-784.
11.	Buell JF， Thomas MT， Rudich S， et al. Experience with more than 500 minimally invasive hepatic procedures [J]. Ann Surg，2008， 248(3)：475-486.
12.	Endo Y， Ohta M， Sasaki A， et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma [J]. Surg Laparosc Endosc Percutan Tech， 2009， 19(5)：171-174.
13.	Gustafson JD， Fox JP， Ouellette JR， et al. Open versus laparoscopic liver resection：looking beyond the immediate postoperative period [J]. Surg Endosc， 2012， 26(2)：468-472.
14.	Zhou YM， Shao WY， Zhao YF， et al. Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma [J].Dig Dis Sci， 2011， 56(7)：1937-1943.
15.	Buell JF， Cherqui D， Geller DA， et al. The international position on laparoscopic liver surgery：The Louisville Statement，2008 [J]. Ann Surg， 2009， 250(5)：825-830.
16.	Giulianotti PC， Coratti A， Sbrana F， et al. Robotic liver surgery：results for 70 resections [J]. Surgery， 2011， 149(1)：29-39.
17.	Giulianotti PC， Addeo P， Bianco FM. Robotic right hepatectomy for giant hemangioma in a Jehovah’s Witness [J]. J Hepatobiliary Pancreat Sci， 2011 ， 18(1)：112-118.
18.	Giulianotti PC， Sbrana F， Coratti A， et al. Totally robotic right hepatectomy：surgical technique and outcomes [J]. Arch Surg，2011， 146(7)：844-850.
19.	Giulianotti PC， TzvetanovⅠ， Jeon H， et al. Robot-assisted right lobe donor hepatectomy [J]. Transpl Int. 2012， 25(1)：e5- e9.
20.	Choi GH， Choi SH， Kim SH， et al. Robotic liver resection：technique and results of 30 consecutive procedures [J]. Surg Endosc， 2012 Feb 4. [ Epub ahead of print].
21.	Chan OC， Tang CN， Lai EC， et al. Robotic hepatobiliary and pancreatic surgery：a cohort study [J]. J Hepatobiliary Pancreat Sci， 2011， 18(4)：471-480.
22.	Ji WB， Wang HG， Zhao ZM， et al. Robotic-assisted laparoscopic anatomic hepatectomy in China：initial experience [J]. Ann Surg， 2011， 253(2)：342-348.
23.	Berber E， Akyildiz HY， Aucejo F， et al. Robotic versus laparoscopic resection of liver tumours [J]. HPB (Oxford)， 2010，12(8)：583-586.
24.	Panaro F， Piardi T， Cag M， et al. Robotic liver resection as a bridge to liver transplantation [J]. JSLS， 2011， 15(1)：86-89.
25.	Casciola L， Patriti A， Ceccarelli G， et al. Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments [J]. Surg Endosc， 2011， 25(12)：3815-3824.
26.	Fong Y， Jarnagin W， Conlon K， et al. Hand-assisted laparoscopic liver resection：lessons from an initial experience [J].Arch Surg， 2000， 135(7)：854-859.

1. Reich H， McGlynn F， DeCaprio J， et al. Laparoscopic excision of benign liver lesions [J]. Obstet Gynecol， 1991， 78(5 Pt 2)：956-958.
2. Rau HG， Meyer G， Cohnert TU， et al. Laparoscopic liver resection with the water-jet dissector [J]. Surg Endosc， 1995， 9(9)：1009-1012.
3. Hashizume M， Takenaka K， Yanaga K， et al. Laparoscopic hepatic resection for hepatocellular carcinoma [J]. Surg Endosc，1995， 9(12)：1289-1291.
4. Kaneko H， Takagi S， Shiba T. Laparoscopic partial hepatectomy and left lateral segmentectomy：technique and results of a clinical series [J]. Surgery， 1996， 120(3)：468-475.
5. Samama G， Chiche L， Bréfort JL， et al. Laparoscopic anatomical hepatic resection. Report of four left lobectomies for solid tumors [J]. Surg Endosc， 1998， 12(1)：76-78.
6. Yamanaka N， Tanaka T， Tanaka W， et al. Laparoscopic partial hepatectomy [J]. Hepatogastroenterology， 1998， 45(19)：29-33.
7. Rau HG， Buttler E， Meyer G， et al. Laparoscopic liver resection compared with conventional partial hepatectomy—— a prospective analysis [J]. Hepatogastroenterology， 1998， 45(24)：2333-2338.
8. Asahara T， Dohi K， Nakahara H， et al. Laparoscopy-assisted hepatectomy for a large tumor of the liver [J]. Hiroshima J Med Sci， 1998， 47(4)：163-166.
9. Cuschieri A. Laparoscopic hand-assisted surgery for hepatic and pancreatic disease [J]. Surg Endosc， 2000， 14(11)：991-996.
10. Giulianotti PC， Coratti A， Angelini M， et al. Robotics in general surgery：personal experience in a large community hospital [J].Arch Surg，2003，138(7)：777-784.
11. Buell JF， Thomas MT， Rudich S， et al. Experience with more than 500 minimally invasive hepatic procedures [J]. Ann Surg，2008， 248(3)：475-486.
12. Endo Y， Ohta M， Sasaki A， et al. A comparative study of the long-term outcomes after laparoscopy-assisted and open left lateral hepatectomy for hepatocellular carcinoma [J]. Surg Laparosc Endosc Percutan Tech， 2009， 19(5)：171-174.
13. Gustafson JD， Fox JP， Ouellette JR， et al. Open versus laparoscopic liver resection：looking beyond the immediate postoperative period [J]. Surg Endosc， 2012， 26(2)：468-472.
14. Zhou YM， Shao WY， Zhao YF， et al. Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma [J].Dig Dis Sci， 2011， 56(7)：1937-1943.
15. Buell JF， Cherqui D， Geller DA， et al. The international position on laparoscopic liver surgery：The Louisville Statement，2008 [J]. Ann Surg， 2009， 250(5)：825-830.
16. Giulianotti PC， Coratti A， Sbrana F， et al. Robotic liver surgery：results for 70 resections [J]. Surgery， 2011， 149(1)：29-39.
17. Giulianotti PC， Addeo P， Bianco FM. Robotic right hepatectomy for giant hemangioma in a Jehovah’s Witness [J]. J Hepatobiliary Pancreat Sci， 2011 ， 18(1)：112-118.
18. Giulianotti PC， Sbrana F， Coratti A， et al. Totally robotic right hepatectomy：surgical technique and outcomes [J]. Arch Surg，2011， 146(7)：844-850.
19. Giulianotti PC， TzvetanovⅠ， Jeon H， et al. Robot-assisted right lobe donor hepatectomy [J]. Transpl Int. 2012， 25(1)：e5- e9.
20. Choi GH， Choi SH， Kim SH， et al. Robotic liver resection：technique and results of 30 consecutive procedures [J]. Surg Endosc， 2012 Feb 4. [ Epub ahead of print].
21. Chan OC， Tang CN， Lai EC， et al. Robotic hepatobiliary and pancreatic surgery：a cohort study [J]. J Hepatobiliary Pancreat Sci， 2011， 18(4)：471-480.
22. Ji WB， Wang HG， Zhao ZM， et al. Robotic-assisted laparoscopic anatomic hepatectomy in China：initial experience [J]. Ann Surg， 2011， 253(2)：342-348.
23. Berber E， Akyildiz HY， Aucejo F， et al. Robotic versus laparoscopic resection of liver tumours [J]. HPB (Oxford)， 2010，12(8)：583-586.
24. Panaro F， Piardi T， Cag M， et al. Robotic liver resection as a bridge to liver transplantation [J]. JSLS， 2011， 15(1)：86-89.
25. Casciola L， Patriti A， Ceccarelli G， et al. Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments [J]. Surg Endosc， 2011， 25(12)：3815-3824.
26. Fong Y， Jarnagin W， Conlon K， et al. Hand-assisted laparoscopic liver resection：lessons from an initial experience [J].Arch Surg， 2000， 135(7)：854-859.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Minimally Invasive Liver Resection：from Laparoscopic to Robotic

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