错误是机器人——机器人供肝切除术后并发症分析。

IF 3.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Liver Transplantation Pub Date : 2025-10-01 Epub Date: 2025-03-07 DOI:10.1097/LVT.0000000000000592
Shweta Mallick, Krishnanunni Nair, Christi Titus Varghese, Binoj Sivasankara Pillai Thankamony Amma, Ramachandran N Menon, Dinesh Balakrishnan, Unnikrishnan Gopalakrishnan, Othiyil Vayoth Sudheer, Sudhindran Surendran
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引用次数: 0

摘要

背景:机器人供肝切除术(RDH)的发病率比开放手术低。捐助者的安全仍然是首要问题,妨碍了其广泛适用。我们的目的是评估RDH后供体并发症并确定其预测因素。研究设计:在2018-2021年间进行的348例活体供肝移植中,采用改进的Clavien-Dindo分级系统分析202例RDH的并发症前瞻性数据。通过供体和手术参数的多变量分析来确定预测并发症的因素,并通过CUSUM分析来评估学习曲线的效果。结果:202例RDH中[平均年龄:37.5(±10.4);f: m-133:69;平均BMI: 25.2±3.84],196例(97%)为改良右叶移植物。7例(3.4%)转为开放[5例出血,1例肝管损伤,1例门静脉扭结]。术后并发症33例(16.3%),最常见的是胆漏(5.9%)和出血(3.9%)。IIIa级、IIIb级和Iva级并发症发生率分别为3.4%、3.4%和0.9%。3例分别因门静脉血栓形成、下腔静脉狭窄、胆道性腹膜炎需要再次手术。在4年的随访中,这些病人的情况都很好。虽然在单因素分析中,较高的失血量和基础代谢指数似乎是显著的,但多因素分析并未显示任何可以预测并发症的供体因素(胆道解剖、门静脉解剖、失血量、BMI、手术时间或FLR容积)。总并发症数(21.7% vs. 9.9%;p = 0.020;(2.53)在下半年大幅下降。在RA-CUSUM分析中,我们发现我们的单位总共花了大约130个案例来克服学习曲线。结论:虽然RDH似乎是安全的,但少数病例可能发生严重并发症。安全在于平坦的学习曲线。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
To Err Is Robot-An analysis of complications following robotic donor hepatectomy.

Robotic donor hepatectomy (RDH) has been reported with lower morbidity than its open counterpart. Donor safety remains the primary concern, precluding its wide adoption. We aimed to evaluate donor complications following RDH and identify their predictive factors. Out of 348 live donor liver transplants performed between 2018 and 2021, the prospective data of 202 RDH were analyzed for complications by the modified Clavien-Dindo grading system. Multivariate analysis of donor and operative parameters was done to identify factors predicting complications, and CUSUM (cumulative sum) analysis was done to evaluate the effect of a learning curve. Out of 202 RDH (mean age: 37.5 [±10.4]; f [female]:m [male]-133:69; mean body mass index: 25.2±3.84), 196 (97%) were modified right lobe grafts. Conversion to open occurred in 7 (3.4%) (5-bleeding, 1-hepatic duct injury, and 1-portal vein kink). Postoperative complications occurred in 33 (16.3%), the most common being bile leak (5.9%) and bleeding (3.9%). Grades IIIa, IIIb, and IVa complications were seen in 3.4%, 3.4%, and 0.9% of patients, respectively. Reoperation was required in 3 cases for PVT, narrowing of IVC, and biliary peritonitis, respectively. At follow ups of 4 years, these patients are doing well. Although in univariate analysis, higher blood loss and body mass index appeared to be significant, multivariate analysis did not reveal any donor factor that could predict complications (biliary anatomy, portal anatomy, blood loss, body mass index, duration of surgery, or future liver remnant volume). The number of overall complications (21.7% vs. 9.9%; p =0.020; OR, 2.53) came down significantly in the second half. On RA-CUSUM (risk-adjusted CUSUM) analysis, we identified that it took around 130 cases for our unit to collectively overcome the learning curve. Although RDH appears to be safe, critical complications can occur in a minority of cases. Safety lies in flattening the learning curve.

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来源期刊
Liver Transplantation
Liver Transplantation 医学-外科
CiteScore
7.40
自引率
6.50%
发文量
254
审稿时长
3-8 weeks
期刊介绍: Since the first application of liver transplantation in a clinical situation was reported more than twenty years ago, there has been a great deal of growth in this field and more is anticipated. As an official publication of the AASLD, Liver Transplantation delivers current, peer-reviewed articles on liver transplantation, liver surgery, and chronic liver disease — the information necessary to keep abreast of this evolving specialty.
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