机器人肝切除术与开放式肝切除术相比效果如何？

StephenW

机器人肝切除术与开放式肝切除术相比效果如何？
2022 年 12 月 8 日
2 分钟
肝病科

根据一项新的队列研究，与开放式肝切除术相比，机器人肝切除术具有更好的围手术期耐受性。 由于肝脏失代偿的风险，许多患者被排除在治疗之外，而机器人肝脏切除术将扩大能够接受治疗的患者数量，因为微创技术可以降低复杂肝切除术转为开放切除术的风险。 虽然与腹腔镜手术相比，机器人手术已显示出优势，但该手术的长期肿瘤学结果仍存在争议，而且其成本很高。

意大利摩德纳和雷焦艾米利亚大学的作者 Fabrizio Di Benedetto 及其同事检查了 2010 年 1 月 1 日至 2020 年 9 月 30 日期间接受过开放式肝切除术或机器人肝切除术的 398 名患者的数据。总共有 106 名患者接受了 开放切除术与 106 名接受机器人手术的患者相匹配。 对于机器人手术，使用了 Xi 或达芬奇 Si 平台。 虽然手术时间更长（295 分钟对 200 分钟），但机器人手术导致住院时间更短（4 天对 10 天），入住 ICU 的次数更少（6.6% 对 19.8%）。 此外，机器人手术的肝衰竭发生率较低（7.5% 对 28.3%），并且不会导致 Grace C 肝衰竭。

虽然两组的术后并发症发生率、90 天总生存期和 24 个月时肿瘤复发相关死亡率相似，但接受开放性切除术的患者发生严重并发症的风险更高（11.3% 对 2.8%）， 机器人切除组的 24 个月总生存率更高（86.9% 对 83.8%）。 输注或输血的浓缩红细胞单位数量没有差异。 总体而言，3.2% 的机器人手术需要术中转为开放切除术。

该研究的局限性包括非随机、回顾性研究设计。 机器人手术的费用仍然高于开放性切除术； 然而，研究人员指出，住院时间减少 6 天，以及严重并发症和 ICU 入院率的减少，显着降低了医院的成本。

StephenW

How Effective is Robotic Liver Resection Compared To Open Resection?
8th December 2022
2 Mins
Hepatology

ROBOTIC liver resection has better perioperative tolerability compared to open liver resection, according to a new cohort study. Due to the risk of liver decompensation, many patients are excluded from treatment, and robotic liver resection would expand the number of patients who are able to be treated, as the minimally invasive technique may lower the risk of conversion to open resection for complex hepatectomies. While robotic surgery has shown benefits compared to laparoscopic surgery, the long-term oncologic outcomes of the surgery are still debated, and its costs are high.

Author Fabrizio Di Benedetto, University of Modena and Reggio Emilia, Italy, and colleagues, examined data from 398 patients who had undergone an open liver resection or robotic liver resection from 1st January 2010–30th September 2020. In total, 106 patients who underwent an open resection were matched to 106 patients who had robotic surgery. For robotic surgery, the Xi or da Vinci Si platforms were used. While the duration of surgery was longer (295 versus 200 minutes), robotic surgery led to shorter stays in hospital (4 days versus 10 days), and fewer ICU admissions (6.6% versus 19.8%). Furthermore, robotic surgery had a lower incidence of liver failure (7.5% versus 28.3%), and did not lead to grace C liver failure.

While the postoperative complication rates, overall survival at 90 days, and tumour recurrence-related mortality at 24 months were similar in the two groups, the risk of severe complications was higher in patients who had an open resection (11.3% versus 2.8%), and overall survival at 24 months was better in the group that had a robotic resection (86.9% versus 83.8%). There were no differences in quantity of packed red blood cells units transfused or blood transfusions. Overall, 3.2% of robotic procedures required an intraoperative conversion to an open resection.

Limitations of the study included the non-randomised, retrospective study design. The cost of robotic surgery is still higher than open resections; however, the researchers pointed out that the reduction in hospitalisation by 6 days, as well as the reduction in severe complications and ICU admissions, reduce the costs for the hospital significantly.