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.
ObjectiveTo discuss the feasibility, safety, and superiority of da Vinci surgery system (DVSS) in liver tumor resection. MethodThe clinical data of 21 patients who underwent DVSS in the liver tumor resection were analyzed retrospectively. ResultsThere were 12 patients with hepatocellular carcinoma (HCC), 1 patient with cholang-iocellular carcinoma, 1 patient with hepatic cirrhosis regenerative nodule, 2 patients with metastatic adenocarcinoma, 2 patients with leiomyosarcoma, and 3 patients with cavernous hemangioma.The operative time was (156.67±92.19) min (60-480 min), the intraoperative blood loss was (585.71±1 076.12) mL (50-5 000 mL), the time of diet recovery was (3.23±1.26) d (2-6 d), and the hospital stay was (10.10±9.02) d (5-47 d).The hospital mortality and morbidity rates were 0(0/21) and 9.52%(2/21) respectively including 1 patient with biliary leakage and 1 patient with abdominal infection. ConclusionThis study demonstrates the feasibility and safety of DVSS in the liver tumor resection and the system has a wide range of application for patients who are suffering from liver tumor.