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Minerva Chirurgica 2018 October;73(5):460-8

DOI: 10.23736/S0026-4733.18.07651-4


lingua: Inglese

Robot-assisted liver surgery in a general surgery unit with a “Referral Centre Hub&Spoke Learning Program”. Early outcomes after our first 70 consecutive patients

Graziano CECCARELLI 1, 2, 3, 4, Enrico ANDOLFI 1, Andrea FONTANI 1, Fulvio CALISE 3, Aldo ROCCA 1, 2, 3, 5 , Antonio GIULIANI 3

1 Unit of General and Robotic Surgery, San Donato Hospital, Arezzo, Italy; 2 Unit of Hepato-Biliary Surgery, P.O. Pineta Grande Hospital, Castel Volturno, Caserta, Italy; 3 Department of Medicine and Health’s Sciences “V. Tiberio”, University of Molise, Campobasso, Italy; 4 Department of General and Robotic Surgery, San Giovanni Battista Hospital, Foligno, Perugia, Italy; 5 Department of Colorectal Cancer Surgery, G. Pascale Foundation and Institute for Research and Care, Naples, Italy

BACKGROUND: The aim of this study was to evaluate safety, feasibility and short-term outcomes of our first 70 consecutive patients treated by robotic-assisted liver resection after a reversal proctoring between a high HPB volume centre and our well-trained center in minimally invasive General Surgery. Six surgeons were involved in this Hub&Spoke learning program.
METHODS: From September 2012 to December 2016, 70 patients underwent robotic-assisted liver resections (RALR). We treated 18 patients affected by colorectal and gastric cancer with synchronous liver lesions suspected for metastases in a one-stage robotic-assisted procedure. For the first 20 procedures we had a tutor in the operatory room, who was present also in the next most difficult procedures.
RESULTS: The 30- and 90-day mortality rate was zero with an overall morbidity rate of 10.1%. Associated surgical procedures were performed in about 65,7% of patients. The observed conversion rate was 10%. The results of the first 20 cases were similar to the next 50 showing a shortned learning curve.
CONCLUSIONS: Minimally invasive robot-assisted liver resection is a safe technique; it allows overcoming many limits of conventional laparoscopy. This innovative, time-enduring Hub&Spoke may allow patients to undergo a proper standard of care also for complex surgical procedures, without the need of reaching referral centres.

KEY WORDS: Liver surgery - Minimally invasive surgical procedures - Laparoscopy - Liver neoplasms

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