Minimally Invasive Approaches in Liver Surgery

2018 ◽  
Author(s):  
Waseem Lutfi ◽  
Melissa E Hogg
Keyword(s):  
Minimally Invasive ◽  
Liver Surgery ◽  
Oncologic Outcomes ◽  
Operative Techniques ◽  
Long Term Outcomes ◽  
Short Term ◽  
Minimally Invasive Liver Surgery ◽  
Key Words Clinical Trials ◽  
Widespread Dissemination

Minimally invasive approaches for liver surgery are being increasingly used at highly specialized centers. Both laparoscopic and robotic techniques appear to be associated with improved short-term outcomes such as decreased morbidity and shorter hospital stay. However, there are still concerns with regard to cost-effectiveness and technical training that have prevented widespread dissemination of these techniques. Within the realm of liver surgery, laparoscopic approaches have gained acceptance; however, robotic surgery still remains a relatively new technique. This chapter discusses the preoperative considerations and operative techniques of minimally invasive liver surgery, while also reviewing the current literature detailing short-term and long-term outcomes. This review contains 6 figures, 5 tables and 33 references Key Words: clinical trials, laparoscopic, liver cancer, minimally invasive, morbidity, mortality, oncologic outcomes, open, robot-assisted,

scholarly journals Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mirhasan Rahimli ◽  
Aristotelis Perrakis ◽  
Vera Schellerer ◽  
Andrew Gumbs ◽  
Eric Lorenz ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Long Term Outcomes ◽  
Short Term ◽  
Minimally Invasive Liver Surgery ◽  
Previous Abdominal Surgery

Abstract Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

Minimally Invasive Approaches in Pancreatic Surgery

2018 ◽  
Author(s):  
Waseem Lutfi ◽  
Melissa E Hogg
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Surgery ◽  
Standard Of Care ◽  
High Volume ◽  
Oncologic Outcomes ◽  
Short Term ◽  
Pancreatic Resections ◽  
Key Words Clinical Trials ◽  
Minimally Invasive Pancreatic Surgery

Minimally invasive approaches for pancreatic resections are being increasingly utilized at highly specialized centers. Both laparoscopic and robotic techniques appear to be associated with improved short-term outcomes such as decreased morbidity and shorter hospital stay. However, there are still concerns with regards to cost-effectiveness and technical training, which have prevented widespread dissemination of these techniques. For pancreatic surgery, both laparoscopic and robotic techniques have gained acceptance for all pancreatic resections, most notably in distal pancreatectomy where minimally invasive approaches have become the standard of care at high-volume centers. This chapter discusses the preoperative considerations and operative techniques of minimally invasive pancreatic surgery while also reviewing the current literature detailing short-term and long-term outcomes. This review contains 46 references, 6 figures, 5 tables, and 2 videos. Key Words: clinical trials, laparoscopic, minimally invasive, morbidity, mortality, oncologic outcomes, open, pancreatic cancer, robot-assisted

Minimally invasive esophagectomy is associated with superior survival, lymphadenectomy and surgical margins: propensity matched analysis of the National Cancer Database

2020 ◽  
Vol 33 (10) ◽  
Author(s):  
Stephanie G Worrell ◽  
Katelynn C Bachman ◽  
Anuja L Sarode ◽  
Yaron Perry ◽  
Philip A Linden ◽  
...  
Keyword(s):  
Overall Survival ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Rank Test ◽  
National Cancer Database ◽  
Long Term Outcomes ◽  
Short Term ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Abstract Despite excellent short-term outcomes of minimally invasive esophagectomy (MIE), there is minimal data on long-term outcomes compared to open esophagectomy. MIE’s superior visualization may have improved lymphadenectomy and complete resection rate and therefore improved long-term outcomes. We hypothesized that MIE would have superior long-term survival. Patients undergoing an esophagectomy for cancer between 2010 and 2016 were identified in the National Cancer Database. MIE included laparoscopic/robotic approach, and conversions were categorized as open. A 1:1 propensity match was performed. Lymphadenectomy and margin status were compared between MIE and open using Stuart Maxwell marginal homogeneity and Wilcoxon matched-pair signed-rank test. Survival was compared using log-rank test. 13,083 patients were identified: 8,906 (68%) open and 4,177 (32%) MIE. Propensity matching identified 3,659 ‘pairs’ of MIE and open esophagectomy patients. Among them, MIE was associated with higher number lymph nodes examined (16 vs. 14, P < 0.001) and similar number of positive lymph nodes (0 vs. 0, P = 0.33). MIE had higher rate of negative pathologic margin (95 vs. 93.5%, P < 0.001). MIE was also associated with shorter hospitalization (9 vs. 10 days, P < 0.001). Survival was improved among MIE patients (46.6 vs. 41.4 months for open, P = 0.003) and among pathologic node-negative patients (71.4 vs. 61.5 months, P = 0.005). These data suggest that MIE has improved short-term outcomes (improved lymphadenectomy, pathologic margins, and length of stay) and also associated improved overall survival. The etiology of superior overall survival is likely secondary to many factors related and unrelated to surgical approach.

scholarly journals Does minimally invasive liver resection improve long-term survival compared to open resection for hepatocellular carcinoma? A systematic review and meta-analysis

2021 ◽  
pp. 145749692110424
Author(s):  
Sivesh K. Kamarajah ◽  
Rohan R. Gujjuri ◽  
Moh’d A. Hilal ◽  
Derek M. Manas ◽  
Steven A. White
Keyword(s):  
Hepatocellular Carcinoma ◽  
Confidence Interval ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Odds Ratio ◽  
Term Survival ◽  
Long Term Survival ◽  
Minimally Invasive Liver Surgery ◽  
Disease Specific

Introduction: Minimally invasive liver surgery for hepatocellular carcinoma has gained widespread interest as an alternative to conventional open liver surgery. However, long-term survival benefits of this approach seem unclear. This meta-analysis was conducted to investigate long-term survival following minimally invasive liver surgery. Method: A systematic review was performed to identify studies comparing long-term survival after minimally invasive liver surgery and open liver surgery until January 2020. The I2 test was used to test for statistical heterogeneity and publication bias was assessed using Egger test. Random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year and 3-year survival outcomes with adjustment for study factors (region, design), annual center volume, patient factors (American Society of Anesthesiologists (ASA) grade, gender, age, body mass index, cirrhosis, tumor size, and number), and resection extent. Sensitivity analyses were performed on studies by study year, region, annual center volume, and resection type. Result: The review identified 50 relevant studies including 13,731 patients undergoing liver resection for hepatocellular carcinoma of which 4071 (25.8%) underwent minimally invasive liver surgery. Pooled analysis revealed similar all-cause (odds ratio: 0.83, 95% confidence interval: 0.70–1.11, p = 0.3) and disease-specific (odds ratio: 0.93, 95% confidence interval: 0.80–1.09, p = 0.4) 5-year mortality after minimally invasive liver surgery compared with open liver surgery. Sensitivity analysis of published studies from 2010 to 2019 demonstrated a significantly lower disease-specific 3-year mortality (odds ratio: 0.75, 95% confidence interval: 0.59–0.96, p = 0.022) and all-cause 5-year mortality (odds ratio: 0.63, 95% confidence interval: 0.50–0.81, p = 0.002). Meta-regression identified no confounding factors in all analyses. Conclusions: Improvement in minimally invasive liver surgery techniques over the past decade appears to demonstrate superior disease-specific mortality with minimally invasive liver surgery compared to open liver surgery. Therefore, minimally invasive liver surgery can be recommended as an alternative surgical approach for hepatocellular carcinoma.

Minimally Invasive Versus Open Treatment for Benign Sporadic Insulinoma Comparison of Short-Term and Long-Term Outcomes

2018 ◽  
Vol 42 (10) ◽  
pp. 3223-3230 ◽  
Author(s):  
Giulio Belfiori ◽  
Dominik Wiese ◽  
Stefano Partelli ◽  
Sabine Wächter ◽  
Elisabeth Maurer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Long Term Outcomes ◽  
Short Term ◽  
Open Treatment

Minimally invasive versus open treatment for benign sporadic insulinoma Comparison of short term and long term outcomes

Pancreatology ◽  
2018 ◽  
Vol 18 (4) ◽  
pp. S85 ◽  
Author(s):  
Giulio Belfiori ◽  
Dominik Wiese ◽  
Stefano Partelli ◽  
Sabine Wächter ◽  
Elisabeth Maurer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Long Term Outcomes ◽  
Short Term ◽  
Open Treatment

Abstract #238: Improved Short Term and Long Term Outcomes of Early Insulin Initiation in Type 2 Diabetes Over 10 Years

2017 ◽  
Vol 23 ◽  
pp. 50
Author(s):  
Jothydev Kesavadev ◽  
Shashank Joshi ◽  
Banshi Saboo ◽  
Hemant Thacker ◽  
Arun Shankar ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Initiation ◽  
Long Term Outcomes ◽  
Short Term
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