Implementation and Outcome of Robotic Liver Surgery in the Netherlands: A Nationwide Analysis.

Autor:	Görgec B; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Zwart M; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Nota CL; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., Bijlstra OD; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Bosscha K; Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands., de Boer MT; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands., de Wilde RF; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands., Draaisma WA; Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands., Gerhards MF; Department of Surgery, OLVG, Amsterdam, the Netherlands., Liem MS; Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands., Lips DJ; Department of Surgery, Medical Spectrum Twente, Enschede, the Netherlands., Marsman HA; Department of Surgery, OLVG, Amsterdam, the Netherlands., Mieog JSD; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Molenaar QI; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands., Nijkamp M; Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands., Te Riele WW; Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands., Terkivatan T; Department of Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands., Vahrmeijer AL; Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands., Besselink MG; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands., Swijnenburg RJ; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, Amsterdam, the Netherlands.; Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Surgery, Amsterdam, the Netherlands., Hagendoorn J; Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Jun 01; Vol. 277 (6), pp. e1269-e1277. Date of Electronic Publication: 2022 Jul 18.
DOI:	10.1097/SLA.0000000000005600
Abstrakt:	Objective: To determine the nationwide implementation and surgical outcome of minor and major robotic liver surgery (RLS) and assess the first phase of implementation of RLS during the learning curve. Background: RLS may be a valuable alternative to laparoscopic liver surgery. Nationwide population-based studies with data on implementation and outcome of RLS are lacking. Methods: Multicenter retrospective cohort study including consecutive patients who underwent RLS for all indications in 9 Dutch centers (August 2014-March 2021). Data on all liver resections were obtained from the mandatory nationwide Dutch Hepato Biliary Audit (DHBA) including data from all 27 centers for liver surgery in the Netherlands. Outcomes were stratified for minor, technically major, and anatomically major RLS. Learning curve effect was assessed using cumulative sum analysis for blood loss. Results: Of 9437 liver resections, 400 were RLS (4.2%) procedures including 207 minor (52.2%), 141 technically major (35.3%), and 52 anatomically major (13%). The nationwide use of RLS increased from 0.2% in 2014 to 11.9% in 2020. The proportion of RLS among all minimally invasive liver resections increased from 2% to 28%. Median blood loss was 150 mL (interquartile range 50-350 mL] and the conversion rate 6.3% (n=25). The rate of Clavien-Dindo grade ≥III complications was 7.0% (n=27), median length of hospital stay 4 days (interquartile range 2-5) and 30-day/in-hospital mortality 0.8% (n=3). The R0 resection rate was 83.2% (n=263). Cumulative sum analysis for blood loss found a learning curve of at least 33 major RLS procedures. Conclusions: The nationwide use of RLS in the Netherlands has increased rapidly with currently one-tenth of all liver resections and one-fourth of all minimally invasive liver resections being performed robotically. Although surgical outcomes of RLS in selected patient seem favorable, future prospective studies should determine its added value. Competing Interests: The authors report no conflicts of interest. (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
Databáze:	MEDLINE
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