Graziano Ceccarelli1,2,3,4, Enrico Andolfi1, Andrea Fontani1, Fulvio Calise3, Aldo Rocca5,2,3,6, Antonio Giuliani3. 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. Unit of General and Robotic Surgery, San Donato Hospital, Arezzo, Italy - aldorocca88@gmail.com. 6. Department of Colorectal Cancer Surgery, G. Pascale Foundation and Institute for Research and Care, Naples, Italy.
Abstract
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.
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.
Authors: Graziano Ceccarelli; Aldo Rocca; Michele De Rosa; Andrea Fontani; Fabio Ermili; Enrico Andolfi; Walter Bugiantella; Giovanni Battista Levi Sandri Journal: Updates Surg Date: 2021-04-08
Authors: Manuel Durán; Javier Briceño; Ana Padial; Ferdinando Massimiliano Anelli; Juan Manuel Sánchez-Hidalgo; María Dolores Ayllón; Rafael Calleja-Lozano; Carmen García-Gaitan Journal: World J Hepatol Date: 2022-01-27
Authors: Antonio Buondonno; Pasquale Avella; Micaela Cappuccio; Andrea Scacchi; Roberto Vaschetti; Giancarlo Di Marzo; Pietro Maida; Claudio Luciani; Bruno Amato; Maria Chiara Brunese; Daniela Esposito; Lucio Selvaggi; Germano Guerra; Aldo Rocca Journal: Front Surg Date: 2022-03-24