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中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (01) : 56 -59. doi: 10.3877/cma.j.issn.1674-6899.2023.01.014

病例报告

机器人解剖性右肝后叶切除术
周鹏宇1, 涂志坚1, 李传富1, 雷晓华1, 陈国栋1,()   
  1. 1. 421001 衡阳,南华大学附属第一医院肝胆胰外科
  • 收稿日期:2023-01-01 出版日期:2023-02-28
  • 通信作者: 陈国栋
  • 基金资助:
    湖南省自然科学基金(科卫联合项目)(2021JJ70039); 湖南省临床医疗技术创新引导项目(2020SK51817); 湖南省卫生健康委员会科技计划项目(20201064,20201919); 湖南省教育厅重点科研项目(21A0258); 南华大学医学临床研究"4310"计划培育项目(20224310NHYCG01)

Robotic anatomical right posterior hepatic lobectomy

Pengyu Zhou1, Zhijian Tu1, Chuanfu Li1, Xiaohua Lei1, Guodong Chen1,()   

  1. 1. The First Affiliated Hospital of University of South China, Department of Hepatopancreatobiliary Surgery, Hengyang 421001, China
  • Received:2023-01-01 Published:2023-02-28
  • Corresponding author: Guodong Chen
引用本文:

周鹏宇, 涂志坚, 李传富, 雷晓华, 陈国栋. 机器人解剖性右肝后叶切除术[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(01): 56-59.

Pengyu Zhou, Zhijian Tu, Chuanfu Li, Xiaohua Lei, Guodong Chen. Robotic anatomical right posterior hepatic lobectomy[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(01): 56-59.

目的

探讨应用达芬奇机器人行解剖性右肝后叶切除术的可行性、安全性及优势。

方法

选取南华大学附属第一医院于2020年12月收治的1例61岁男性肝肿瘤患者,腹部增强CT及MRI提示肝S6、S7段肝细胞癌可能,肿瘤大小约80 mm×60 mm。评估无明显手术禁忌证后,经充分术前准备,拟在全身麻醉下行机器人解剖性右肝后叶切除术,围手术期实施加速康复外科管理模式。

结果

手术顺利,手术时间约150 min,术中出血量约100 mL,术后无肝衰竭、出血、感染等并发症,术后7 d出院。术后病理示肝细胞癌,切缘均为阴性,术后4个月和10个月复查CT未见肿瘤复发、转移征象。

结论

机器人行解剖性右肝后叶切除术是安全、可行的。

Objective

To explore the feasibility, safety and advantage of using da Vinci robot for anatomic right posterior hepatic lobectomy.

Methods

A case of focal liver lesions admitted to the First Affiliated Hospital of University of South China in Dec. 2020 was selected. A 61-year-old male found a hepatocellular carcinoma by the enhanced abdominal CT, located in S6 and S7 segments, and the size was about 80 mm×60 mm. Robot anatomical right posterior hepatic lobectomy was performed under general anesthesia, and ERAS management mode was applied in perioperative period.

Results

The operation was successful, the operation time was about 150 min, and the intraoperative blood loss was about 100 mL. There were no postoperative complications such as liver failure, bleeding and infection. The patient was discharged on the 7 days after operation. Postoperative pathology showed that the incisal margin was negative, and there were no signs of tumor recurrence and metastasis in CT at 4 and 10 months after operation.

Conclusions

Robot right posterior hepatic lobectomy is safe and feasible.

图1 术前MRI结果
图2 术前三维重建结果
图3 自制橡皮圈悬吊肝脏
图4 解剖并离断门静脉右后支
图5 显露并离断右肝后胆管
图6 切除后术区展示
1
Sohn W, Lee HW, Lee S, et al. Obesity and the risk of primary liver cancer: a systematicreview and meta-analysis[J]. Clin Mol Hepatol, 2021, 27(1):157-174.
2
中华人民共和国国家卫生健康委员会医政医管局.原发性肝癌诊疗指南(2022年版)[J]. 中国实用外科杂志2022, 42(3): 241-273.
3
Montalti R, Scuderi V, Patriti A, et al. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison[J]. Surg Endosc, 2016, 30(3):1004-1013.
4
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.
5
刘荣,赵之明. 机器人在肝胆胰外科的创新与发展[J/CD]. 中华腔镜外科杂志(电子版), 2017, 10(5):267-269.
6
马靖雯,孟尧,何天霖. 机器人肝脏切除手术的临床现状与研究进展[J]. 机器人外科学杂志(中英文), 2022, 3(1):48-54.
7
Hu Y, Guo K, Xu J, et al. Robotic versus laparoscopic hepatectomy for malignancy: a systematic review and meta-analysis[J]. Asian J Surg, 2021, 44(4):615-628.
8
Kim NR, Han DH, Choi GH, et al. Comparison of surgical outcomes and learning curve for robotic versus laparoscopic living donor hepatectomy: a retrospective cohort study [J]. Int J Surg, 2022, 108: 107000.
9
Khan S, Beard RE, Kingham PT, et al. Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: a multicenter study[J]. Ann Surg Oncol, 2018, 25(9): 2652-2660.
10
Sucandy I, Rayman S, Lai EC, et al. Robotic versus laparoscopic left and extended left hepatectomy: an international multicenter study propensity score-matched analysis[J]. Ann Surg Oncol, 2022, 29(13):8398-8406.
11
Chong CC, Fuks D, Lee KF, et al. Propensity score-matched analysis comparing robotic and laparoscopic right and extended right hepatectomy[J]. JAMA Surg, 2022, 157(5):436-444.
12
D′Silva M, Han HS, Liu R, et al. Limited liver resections in the posterosuperior segments: international multicentre propensity score-matched and coarsened exact-matched analysis comparing the laparoscopic and robotic approaches[J]. Br J Surg, 2022, 109(11):1140-1149.
13
Shinkawa H, Hirokawa F, Kaibori M, et al. Impact of laparoscopic parenchyma-sparing resection of lesions in the right posterosuperior liver segments on surgical outcomes: a multicenter study based on propensity score analysis[J]. Surgery, 2022, 171(5):1311-1319.
14
Endo T, Morise Z, Katsuno H, et al. Caudal approach to laparoscopic liver resection-conceptual benefits for repeated multimodal treatment for hepatocellular carcinoma and extended right posterior sectionectomy in the left lateral position[J]. Front Oncol, 2022, 12:950283.
15
Ferrero A, Lo Tesoriere R, Giovanardi F, et al. Laparoscopic right posterior anatomic liver resections with glissonean pedicle-first and venous craniocaudal approach[J]. Surg Endosc, 2021, 35(1):449-455.
16
Kiguchi G, Sugioka A, Kato Y, et al. Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi-prone position[J]. Surg Oncol, 2019, 29:140-141.
17
Hu M, Hu H, Cai W, et al. The safety and feasibility of three-dimensional visualization technology assisted right posterior lobe allied with part of Ⅴ and Ⅷ sectionectomy for right hepatic malignancy therapy[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(5):586-594.
18
Li J, Li X, Zhang X, et al. Indocyanine green fluorescence imaging-guided laparoscopic right posterior hepatectomy[J]. Surg Endosc, 2022, 36(2):1293-1301.
19
张璐,王经琳,任昊桢,等. 机器人辅助肝切除术临床应用进展 [J/CD]. 中华腔镜外科杂志(电子版), 2021, 14(06): 375-8.

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