title: Laparoscopic robot-assisted resection of tumors located in posterosuperior liver segments.
abstract: Laparoscopic resection of liver tumors located in the posterosuperior segments is a challenging operation that could be facilitated by robotic assistance. Laparoscopic resection of 12 tumors located in posterosuperior segments (IVa: 1; VII: 5; VIII: 6) was carried out under robotic assistance. All patients had a single tumor nodule. Data were collected prospectively and analyzed retrospectively. Surgery required a mean of 260.4 min (115-430) and was completed laparoscopically in all but one patient, who required conversion to mini-laparotomy because of intolerance of pneumoperitoneum (8.3%). Mean estimated blood loss was 252.7 ml (50-600), making transfusion necessary in 3 patients (25.0%). Post-operative complications occurred in 4 patients (33.3%), being of Clavien-Dindo grade II in 3 patients (25.0%) and Clavien-Dindo grade IV in 1 patient (8.3%). Reoperation was required in 1 patient, who subsequently had a long hospital stay, because of decompensated cirrhosis. Median length of hospital stay was 8.5 days (7-96). No patient was readmitted. Pathology showed hepatocellular carcinoma in 7 patients (58.3%), liver metastasis in 2 patients (16.6%), and hepatic adenoma, focal nodular hyperplasia, and hemangioma in one patient each (8.3%). All patients had a margin negative resection. After a mean follow-up period of 21.4 months (±24.4), no patient with malignant histology developed recurrence. Our initial experience confirms that laparoscopic robot-assisted resection of tumors located in the posterosuperior segments is feasible. Further experience is needed before final conclusions can be drawn and meaningful comparison with other surgical techniques becomes possible.
authors.affiliation: Division of General and Transplant Surgery, University of Pisa, Pisa, Italy, u.boggi@med.unipi.it.
authors.forename: Ugo
authors.initials: U
authors.lastname: Boggi
authors.forename: Fabio
authors.initials: F
authors.lastname: Caniglia
authors.forename: Fabio
authors.initials: F
authors.lastname: Vistoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Costa
authors.forename: Erika
authors.initials: E
authors.lastname: Pieroni
authors.forename: Vittorio Grazio
authors.initials: VG
authors.lastname: Perrone
mesh_terms: D000368:Aged; D001707:Biopsy, Needle; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007150:Immunohistochemistry; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D061646:Operative Time; D056888:Patient Positioning; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016019:Survival Analysis; D016896:Treatment Outcome