Parenchymal transection in robotic liver resection: results of 70 resections using the Vessel Sealer

Abstract

Aim: There is no standard technique for transection of the hepatic parenchyma during robotic liver resection. The aim of this study was to describe the outcomes of robotic liver resections using the Vessel Sealer for parenchymal transection.

Methods: This is a post hoc analysis of a prospective database. All consecutive patients who underwent robotic liver resection in the Regional Academic Cancer Centre, Utrecht, Netherlands, between August 2015 and January 2019 were included.

Results: A total of 70 robotic liver resections were performed, including 60 minor resections (86%) and ten hemihepatectomies (14%). Five procedures (7%) were converted. Mean parenchymal transection time was 43 ± 26 min. Median blood loss was 150 mL (interquartile range 40-300). Ten patients (14%) suffered from a major complication, and three patients (4%) had bile leakage postoperatively. One patient died from post-hepatectomy liver failure.

Conclusion: Based on the results of this series, consisting of 60 minor liver resections and 10 hemihepatectomies, we conclude that the use of the Vessel Sealer during the parenchymal transection in liver resection is feasible and safe.

Keywords

Robotic liver resection / minimally-invasive hepatectomy / robot-assisted surgery / robotic surgery / hepatic resection

References

[1] Fretland ÅA,Bjørnelv GMW.Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial..Ann Surg2018;267:199-207

[2] Leung U.Robotic liver surgery..Hepatobiliary Surg Nutr2014;3:288-94 PMCID:PMC4207844

[3] Nota CL,Hagendoorn J.Setting up a robotic hepatectomy program: a Western-European experience and perspective..Hepatobiliary Surg Nutr2017;6:239-45 PMCID:PMC5554759

[4] Nota CL,Molenaar IQ.Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomies..HPB (Oxford)2016;18:113-20 PMCID:PMC4814602

[5] Pamecha V,Sharma D.Techniques for liver parenchymal transection: a meta-analysis of randomized controlled trials..HPB (Oxford)2009;11:275-81 PMCID:PMC2727079

[6] Otsuka Y,Cleary SP.What is the best technique in parenchymal transection in laparoscopic liver resection? Comprehensive review for the clinical question on the 2nd International Consensus Conference on Laparoscopic Liver Resection..J Hepatobiliary Pancreat Sci2015;22:363-70

[7] Ho CM,Nitta H.Systematic review of robotic liver resection..Surg Endosc2012;27:732-9 PMCID:PMC3572385

[8] von Elm E,Egger M.The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies..Int J Surg2014;12:1495-9

[9] Nota CL,Raoof M.Robotic versus open minor liver resections of the posterosuperior segments: a multinational, propensity score-matched study..Ann Surg Oncol2019;26:583-90

[10] Nota CLMA,van Hillegersberg R,Hagendoorn J.Robotic liver resection including the posterosuperior segments: initial experience..J Surg Res2016;206:133-8

[11] Couinaud C.Liver lobes and segments: notes on the anatomical architecture and surgery of the liver..Presse Med1954;62:709-12(in French)

[12] Reddy SK,Turley RS.A standard definition of major hepatectomy: resection of four or more liver segments..HPB (Oxford)2011;13:494-502 PMCID:PMC3133716

[13] Dindo D,Clavien PA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey..Ann Surg2004;240:205-13 PMCID:PMC1360123

[14] Koch M,Padbury R.Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the international study group of liver surgery..Surgery2011;149:680-8

[15] The Royal College of Pathologists. Dataset for histopathology reporting of liver resection specimens (including gall bladder) and liver biopsies for primary and metastatic carcinoma. Available from: https://www.rcpath.org/uploads/assets/cbae24ce-220c-4d9f-95c5b83dd1f0ad2b/Dataset-for-histopathology-reporting-of-liver-resection-specimens-and-liver-biopsies-for-primary-and-metastatic-carcinoma-2nd-edition.pdf. [Last accessed on 13 Aug 2020]

[16] van der Poel MJ,Bemelmans M.Implementation and outcome of minor and major minimally invasive liver surgery in the Netherlands..HPB (Oxford)2019;21:1734-43

[17] Nota CLMA,Borel Rinkes IHM.Robotic right hepatectomy for a central liver tumor- a video of the surgical technique..Surg Oncol2019;30:108

[18] Nota CLMA,Borel Rinkes IHM.Robotic liver resection of segment 7: a step-by-step description of the technique..Surg Oncol2020;34:206-7

[19] Panni RZ,Hawkins WG.National pancreatic fistula rates after minimally invasive pancreaticoduodenectomy are improving with time: a NSQIP analysis..J Am Coll Surg2019;229:192-9.e1

[20] Thakkar R,Alessandri G.Techniques of hepatic transection in robotic surgery - is there still scope for improvement?.Adv Res Gastroentero Hepatol2018;10:555781

[21] Kingham TP,Kuk D.Robotic liver resection: a case-matched comparison..World J Surg2016;40:1422-8 PMCID:PMC4870111

[22] Donadon M,Cimino M.Diagnosis and management of bile leaks after hepatectomy: results of a prospective analysis of 475 hepatectomies..World J Surg2016;40:172-81

[23] Yamashita Y,Rikimaru T.Bile leakage after hepatic resection..Ann Surg2001;233:45-50 PMCID:PMC1421165

[24] Nguyen KT,Geller DA.World review of laparoscopic liver resection-2,804 patients..Ann Surg2009;250:831-41

[25] Takahashi H,Aksoy E.A new technique for hepatic parenchymal transection using an articulating bipolar 5 cm radiofrequency device: results from the first 100 procedures..HPB (Oxford)2018;20:829-33

[26] Sadot E,Leal JN.Resection margin and survival in 2368 patients undergoing hepatic resection for metastatic colorectal cancer: surgical technique or biologic surrogate?.Ann Surg2015;262:476-85discussion 483-5 PMCID:PMC4533113

[27] Viganò L,Cimino MM.R1 resection for colorectal liver metastases: a survey questioning surgeons about its incidence, clinical impact, and management..J Gastrointest Surg2018;22:1752-63