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      Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments : An International Multicenter Study

      1 , 1 , 1 , 1 , 2 , 2 , 3 , 4 , 4 , 5 , 6 , 7 , 7 , 8 , 9 , 9 , 10 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 22 , 23 , 24 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 47 , 48 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 54 , 55 , 55 , 56 , 57 , 58 , 59 , 60 , 60 , 61 , 62 , 62 , 63 , 63 , 6 , 64 , 8 , 56 , 5 , 7 , 4 , 65 , International robotic and laparoscopic liver resection study group investigators
      Annals of Surgery
      Ovid Technologies (Wolters Kluwer Health)

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          Abstract

          Objective:

          The purpose of this study was to compare the outcomes of robotic limited liver resections (RLLR) versus laparoscopic limited liver resections (LLLR) of the posterosuperior segments.

          Background:

          Both laparoscopic and robotic liver resections have been used for tumors in the posterosuperior liver segments. However, the comparative performance and safety of both approaches have not been well examined in the existing literature.

          Methods:

          This is a post hoc analysis of a multicenter database of 5446 patients who underwent RLLR or LLLR of the posterosuperior segments (I, IVa, VII, and VIII) at 60 international centers between 2008 and 2021. Data on baseline demographics, center experience and volume, tumor features, and perioperative characteristics were collected and analyzed. Propensity score-matching (PSM) analysis (in both 1:1 and 1:2 ratios) was performed to minimize selection bias.

          Results:

          A total of 3510 cases met the study criteria, of whom 3049 underwent LLLR (87%), and 461 underwent RLLR (13%). After PSM (1:1: and 1:2), RLLR was associated with a lower open conversion rate [10 of 449 (2.2%) vs 54 of 898 (6.0%); P=0.002], less blood loss [100 mL [IQR: 50–200) days vs 150 mL (IQR: 50–350); P<0.001] and a shorter operative time (188 min (IQR: 140–270) vs 222 min (IQR: 158–300); P<0.001]. These improved perioperative outcomes associated with RLLR were similarly seen in a subset analysis of patients with cirrhosis—lower open conversion rate [1 of 136 (0.7%) vs 17 of 272 (6.2%); P=0.009], less blood loss [100 mL (IQR: 48–200) vs 160 mL (IQR: 50–400); P<0.001], and shorter operative time [190 min (IQR: 141–258) vs 230 min (IQR: 160–312); P=0.003]. Postoperative outcomes in terms of readmission, morbidity and mortality were similar between RLLR and LLLR in both the overall PSM cohort and cirrhosis patient subset.

          Conclusions:

          RLLR for the posterosuperior segments was associated with superior perioperative outcomes in terms of decreased operative time, blood loss, and open conversion rate when compared with LLLR.

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          Most cited references42

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          The Clavien-Dindo classification of surgical complications: five-year experience.

          The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the complication. The principle of the classification was to be simple, reproducible, flexible, and applicable irrespective of the cultural background. The aim of the current study was to critically evaluate this classification from the perspective of its use in the literature, by assessing interobserver variability in grading complex complication scenarios and to correlate the classification grades with patients', nurses', and doctors' perception. Reports from the literature using the classification system were systematically analyzed. Next, 11 scenarios illustrating difficult cases were prepared to develop a consensus on how to rank the various complications. Third, 7 centers from different continents, having routinely used the classification, independently assessed the 11 scenarios. An agreement analysis was performed to test the accuracy and reliability of the classification. Finally, the perception of the severity was tested in patients, nurses, and physicians by presenting 30 scenarios, each illustrating a specific grade of complication. We noted a dramatic increase in the use of the classification in many fields of surgery. About half of the studies used the contracted form, whereas the rest used the full range of grading. Two-thirds of the publications avoided subjective terms such as minor or major complications. The study of 11 difficult cases among various centers revealed a high degree of agreement in identifying and ranking complications (89% agreement), and enabled a better definition of unclear situations. Each grade of complications significantly correlated with the perception by patients, nurses, and physicians (P < 0.05, Kruskal-Wallis test). This 5-year evaluation provides strong evidence that the classification is valid and applicable worldwide in many fields of surgery. No modification in the general principle of classification is warranted in view of the use in ongoing publications and trials. Subjective, inaccurate, or confusing terms such as "minor or major" should be removed from the surgical literature.
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            Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka.

            The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve.
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              • Article: not found

              Nomenclature of hepatic anatomy and resections: a review of the Brisbane 2000 system.

              The Brisbane 2000 system of nomenclature of hepatic anatomy and resections was introduced to provide a universal terminology in an area that was plagued by confusing and inappropriate terminology. The article describes historical developments central to the emergence of the new terminology and describes the terminology, its attributes, and rules of application.
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                Author and article information

                Journal
                Annals of Surgery
                Ovid Technologies (Wolters Kluwer Health)
                0003-4932
                2024
                February 2024
                July 24 2023
                : 279
                : 2
                : 297-305
                Affiliations
                [1 ]Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, and Berlin Institute of Health, Berlin, Germany
                [2 ]Faculty of Hepatopancreatobiliary Surgery, the First Medical Center of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
                [3 ]Hepatic Surgery Center and Hubei Key Laboratory of Hepato-Biliary-Pancreatic Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
                [4 ]Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
                [5 ]Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
                [6 ]Department of Surgery, Fondazione Poliambulanza, Brescia, Italy
                [7 ]Department of HPB Surgery, The Intervention Centre, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
                [8 ]Department of Surgery, Division of General Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
                [9 ]Department of Digestive, HBP and Liver Transplantation, Hopital Pitie-Salpetriere, Sorbonne Universite, Paris, France
                [10 ]Liver Surgery Unit, Department of Gastroenterology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
                [11 ]General Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
                [12 ]Oncologic Surgery Department, P. Giaccone University Hospital, Palermo, Italy
                [13 ]HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano and University of Milan, Milan, Italy
                [14 ]Hepatopancreatobiliary Unit, Department of Surgery, Changi General Hospital, Singapore
                [15 ]Digestive Health Institute, AdventHealth Tampa, Tampa, FL
                [16 ]Department of Abdominal and General Surgery, University Medical Center Maribor, Maribor, Slovenia
                [17 ]Department of General Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
                [18 ]Department of Surgery, Division of Hepato-Biliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
                [19 ]Hepatobiliary Surgery and Liver Transplantation Unit, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Bilbao, Spain
                [20 ]HPB Surgery and Transplantation Unit, Department of Experimental and Clinical Medicine, United Hospital of Ancona, Polytechnic University of Marche, Ancona, Italy
                [21 ]Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy
                [22 ]General and Hepatobiliary Surgery, Department of Surgery, Dentistry, Gynecology and Pediatrics, University of Verona, GB Rossi Hospital, Verona, Italy
                [23 ]Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
                [24 ]Department of Hepatobiliary Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
                [25 ]General and Digestive Surgery, Hospital Clinic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
                [26 ]General and Digestive Surgery, Hospital Universitario La Paz, IdiPAZ, CIBERehd, Madrid, Spain
                [27 ]Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
                [28 ]Department of Surgery, Okazaki Medical Center, Fujita Health University School of Medicine, Okazaki, Japan
                [29 ]HPB Surgery and Liver Transplant Unit, University of Modena and Reggio Emilia, Modena, Italy
                [30 ]Department of Digestive and Hepatobiliary and Pancreatic Surgery, AP-HP, Henri-Mondor Hospital, Creteil, France
                [31 ]Hepatobiliary Surgery Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
                [32 ]Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
                [33 ]Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
                [34 ]Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center—IRCCS-G. Pascale, Naples, Italy
                [35 ]Unit of Hepato-Pancreatc-Biliary Surgery, “F. Miulli” General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
                [36 ]Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center Italy, Palermo, Italy
                [37 ]Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
                [38 ]The Liver Institute, Methodist Dallas Medical Center, Dallas, TX
                [39 ]Department of Surgery, University of Washington Medical Center, Seattle, WA
                [40 ]HPB and Liver Transplant Unit, Department of General Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain & Institute of Health Research of Navarra (IdisNA), Pamplona, Spain
                [41 ]Department of Surgery, Division of Hepatopancreatobiliary Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
                [42 ]Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, El Palmar, Murcia, Spain
                [43 ]Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China
                [44 ]Department of Hepatopancreatobiliary and Liver Transplant Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
                [45 ]Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
                [46 ]Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
                [47 ]Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
                [48 ]Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
                [49 ]Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan
                [50 ]Hepatobiliary and Pancreatic Surgery Unit, Department of Surgery, Dr. Josep Trueta Hospital, IdIBGi, Girona, Spain
                [51 ]Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
                [52 ]Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
                [53 ]Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
                [54 ]Department of Hepatobiliary Surgery, Assistance Publique Hopitaux de Paris, Centre Hepato-Biliaire, Paul-Brousse Hospital, Villejuif, France
                [55 ]Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
                [56 ]Department of Digestive, Oncologic and Metabolic Surgery, Institute Mutualiste Montsouris, Universite Paris Descartes, Paris, France
                [57 ]Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
                [58 ]Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University Hospital Naples, Naples, Italy
                [59 ]Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
                [60 ]Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
                [61 ]Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris Cite, Clichy, France
                [62 ]Department of Surgery, Seoul National University Hospital Bundang, Seoul National University College of Medicine, Seoul, Korea
                [63 ]Department of Hepato-Pancreato-Biliary Surgery, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
                [64 ]Department of Surgery, University Hospital Southampton, Southampton, UK
                [65 ]Surgery Academic Clinical Programme, Duke-National University of Singapore Medical School, Singapore, Singapore
                Article
                10.1097/SLA.0000000000006027
                37485989
                4698fd7b-40e2-4193-8057-1d30248166ff
                © 2023
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