Early outcomes of single-port robotic left lateral sectionectomy in patients with hepatic tumor
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ABSTRACT:
SUBMITTER: Na Y
PROVIDER: S-EPMC10838653 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:The ORANGE II trial is a double blinded randomised controlled trial that will provide evidence on the merits of laparoscopic surgery in patients undergoing a left lateral hepatic sectionectomy in terms of time to functional recovery, hospital length of stay, quality of life, readmission percentage, morbidity and mortality, hospital costs, body image and cosmesis, and long term incidence of incisional hernias.
| 2070253 | ecrin-mdr-crc
Project description:Robotic-assisted laparoscopic surgery in urology is an ever progressing field, and boundaries are constantly broken with the aid of new technology. Advancements in instrumentation have given birth to the era of robotic laparoendoscopic single-site technique (R-LESS). R-LESS however, has not gained widespread acceptance due to technical hurdles such as adequate triangulation, robotic arm clashing, decreased access for the bedside assistant, lack of wrist articulation, continued need for an axillary/accessory port, lack of robust retraction, and ergonomic discomfort. Many innovations have been explored to counter such limitations. We aim to give a brief overview of a history and development of R-LESS urologic surgery and outline the latest advancements in the realm of urologic R-LESS. By searching PubMed selectively for relevant articles, we concluded a literature review. We searched using the keywords: robotic laparoscopic single incision, robotic laparoendoscopic single-site, single incision robotic surgery, and R-LESS. We selected all relevant articles in that pertained to single-site robotic surgery in urology. We selected all relevant articles that pertained to single-site robotic surgery in urology in a table encompassed within this article. The development of the R-LESS procedures, instrumentations, and platforms has been an evolution in progress. Our results showed the history and evolution toward a purpose-built single-port robotic platform that addresses previous limitations to R-LESS. Even though previous studies have shown feasibility with R-LESS, the future of R-LESS depends on the availability of purpose-built robotic platforms. The larger concern is the demonstration of the definitive advantage of single-site over the conventional multiport surgery.
| S-EPMC5532886 | biostudies-other
Project description:IntroductionPure laparoscopy for living donor hepatectomy is gaining popularity due to its advantages. However, despite the long-standing application of laparoscopic donor left lateral sectionectomy, the dissection of the Glisson branch, portal vein, and biliary ducts, particularly those of the caudate lobe, remains insufficiently described. Although the Glissonean approach offers easy standardization for hilar dissection, clear landmarks for parenchymal transection, and reduces postoperative bile leakage, it has not been widely adopted in laparoscopic donor hepatectomy. Here, we introduce a modified Glissonean pedicle approach to address the movement restrictions in laparoscopic surgery.Surgical techniqueAfter liver mobilization, the Glisson of Spiegel lobe (G1L) was divided, followed by encircling the left Glissonean pedicle. A tape for the liver hanging maneuver was placed from the right edge of the left Glissonean pedicle, along the Arantius plate, to the left edge of the left hepatic vein. When the parenchymal transection was completed, the left hepatic vein was automatically taped. The left hepatic artery and left portal vein were exposed, and some branches of P1 were divided to lengthen for anastomosis. The left hepatic duct was taped by removing the left hepatic artery and left hepatic vein from the left Glissonean pedicle. The left hepatic duct was divided under intraoperative cholangiography. Next, the left hepatic artery, left portal vein, and left hepatic vein were sequentially divided, and the graft liver was retrieved.DiscussionOur Glissonean approach can help standardize donor left lateral sectionectomy, minimize the exposure of the left hepatic duct, and clarify B1 branch dissection.
| S-EPMC11893216 | biostudies-literature
Project description: Not available
| S-EPMC11353098 | biostudies-literature
Project description:The use of lLaparoscopic liver resection in terms of time to functional recovery, length of hospital stay (LOS), long-term abdominal wall hernias, costs and quality of life (QOL) has never been studied in a randomised controlled trial. Therefore, this is the subject of the international multicentre randomised controlled ORANGE II trial.Patients eligible for left lateral sectionectomy (LLS) of the liver will be recruited and randomised at the outpatient clinic. All randomised patients will undergo surgery in the setting of an ERAS programme. The experimental design produces two randomised arms (open and laparoscopic LLS) and a prospective registry. The prospective registry will be based on patients that cannot be randomised because of the explicit treatment preference of the patient or surgeon, or because of ineligibility (not meeting the in- and exclusion criteria) for randomisation in this trial. Therefore, all non-randomised patients undergoing LLS will be approached to participate in the prospective registry, thereby allowing acquisition of an uninterrupted prospective series of patients. The primary endpoint of the ORANGE II trial is time to functional recovery. Secondary endpoints are postoperative LOS, percentage readmission, (liver-specific) morbidity, QOL, body image and cosmetic result, hospital and societal costs over 1 year, and long-term incidence of incisional hernias. It will be assumed that in patients undergoing laparoscopic LLS, length of hospital stay can be reduced by two days. A sample size of 55 patients in each randomisation arm has been calculated to detect a 2-day reduction in LOS (90% power and ? = 0.05 (two-tailed)).The ORANGE II trial is a multicenter randomised controlled trial that will provide evidence on the merits of laparoscopic surgery in patients undergoing LLS within an enhanced recovery ERAS programme.ClinicalTrials.gov NCT00874224.
| S-EPMC3409025 | biostudies-literature
Project description:Sleeve lobectomy has solidified its position as a preferred alternative to pneumonectomy due to its significant advantage in preserving lung function, whereas right lower lobe sleeve lobectomy remains relatively uncommon because of the higher technical challenge. With the development of minimally invasive technology and experience acquired over the years, robot-assisted thoracoscopic surgery (RATS) has shown progress and distinct advantages compared to the traditional thoracotomy and video-assisted thoracoscopic surgery (VATS) approach. Owing to its 3D vision, bendable wrist joints, and tremor filtration capabilities, this surgical technique exhibits great advantages in complex thoracic operations demanding for reconstructive procedures compared to traditional thoracoscopic surgery. The Davinci Xi system has been employed in a substantial number of sleeve resections via a single-port approach. However, the Davinci Xi system was first designed for multi-port thoracic surgery, which poses challenges for adaptation to single-port surgery. Additionally, the newer Davinci SP system, with its 2.5 cm port diameter, cannot be inserted through an intercostal incision and can only be utilized for lung surgery via a subcostal incision, thus restricting its application in complex lung surgeries such as sleeve resection. Here we present a case report on a right lower sleeve lobectomy utilizing the innovative Shurui single-port robotic system which exhibits several advantages in the realm of lung surgery compared to traditional procedures.
| S-EPMC11635244 | biostudies-literature
Project description: Not available
| S-EPMC9262738 | biostudies-literature
Project description:BackgroundThe judgment of the division point of the bile duct has always been one of the difficulties of laparoscopic left lateral sectionectomy (LLLS). The purpose of this study was to assess the effects of indocyanine green (ICG) fluorescence cholangiography during LLLS on the occurrence of biliary complications in both donors and recipients. The optimal dose and injection time of ICG were also investigated.MethodsThis is a retrospective cohort study. From October 2016 to December 2022, the clinical data of 103 donors who underwent LLLS and relevant recipients were retrospectively analyzed. According to whether ICG fluorescence cholangiography was used, they were divided into a non-ICG group (n=46) and an ICG group (n=57). Biliary complications were observed and the optimal dose and injection time of ICG were explored.ResultsThree donors in the non-ICG group suffered from bile leakage. Four grafts had multiple bile duct openings and biliary complications were observed in the relevant recipients who received these grafts in the non-ICG group. Two recipients had bile leakage, and the other two had biliary stenosis. There was no biliary complications both in donors and recipients in the ICG group. The fluorescence intensity of the liver was 108.1±17.6 at a dose of 0.004 mg/kg 90 minutes after injection, significantly weaker than that at 0.05 mg/kg 30 minutes (200.3±17.6, P=0.001) and 90 minutes after injection (140.2±15.4, P=0.001). The fluorescence intensity contrast value at a dose of 0.004 mg/kg was stronger than that at 0.05 mg/kg, both measured 90 minutes after injection (0.098±0.032 vs. 0.078±0.022, P=0.021).ConclusionsICG fluorescence cholangiography is safe and feasible in LLLS. It reduces biliary complications in both donors and recipients. The optimal ICG dose was 0.004 mg/kg, and 90 minutes after injection was the best observation time. ICG fluorescence cholangiography is recommended for routine use in LLLS.
| S-EPMC11336537 | biostudies-literature
Project description: Not available
| S-EPMC9177257 | biostudies-literature
Project description:ObjectiveThis study aimed to analyze the usefulness of an additional axillary port in robotic retroauricular thyroidectomy by comparing the perioperative data and postoperative function between the operations with and without an additional axillary port.Materials and methodsA retrospective review of the medical records of 11 patients who underwent robotic thyroid operations using a unilateral retroauricular approach with or without an additional axillary port between 2016 and 2021 was conducted. Patient demographics, operation time, drainage amount, hospital stay, complication, postoperative cosmetic satisfaction, and postoperative neck and shoulder pain were analyzed.ResultsAmong the 11 patients who underwent robotic retroauricular thyroidectomy, an additional axillary port was used in 6 patients and not used in 5 patients. The total operation time was significantly shorter in the axillary port group (174.5 ± 23 minutes) compared to the without the axillary port group (207.6 ± 20.1 minutes) (P = .033). The intraoperative estimated blood loss (P = .525), total amount of drainage (P = .172), and postoperative hospital stays (P = .092) were not different between the 2 groups. There was no postoperative recurrent laryngeal nerve palsy, hypoparathyroidism, hematoma, seroma in the two groups. There was no significant difference for either group in the pain score and cosmetic satisfaction at 2 weeks (P = .378, P = .650) and 6 weeks (P = .242, P = .546) postoperatively.ConclusionRobotic retroauricular thyroidectomy using an additional axillary port was a novel, safe, and feasible procedure. Dissection was easy due to the availability of the fourth robotic arm to retract the thyroid gland.Level of Evidence: 4.
| S-EPMC8356877 | biostudies-literature