- Email: [email protected]
Robotic hepatobiliary and pancreatic surgery: Initial experience from a UK centre
e274
Electronic Poster Abstracts
EP01D-032 APPLICATION OF MEDICAL IMAGE THREE-DIMENSIONAL VISUALIZATION SYSTEM (MI-3DVS) SYSTEM IN THE DIAGNOSIS AND TREATMENT OF LIVER TRAUMA C. -H. Fang Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, China Introduction: This study was use MI-3DVS system reconstruction 30 cases of hepatic trauma patients, observation of three-dimensional imaging features of liver trauma. Methods: Application of MI-3DVS system for 3D reconstruction of patients with liver trauma, the trauma site, nature, scope by three-dimensional reconstruction, if the patients need for operation, in comparison with preoperative 3D reconstruction, can help physicians decide the size of operation mode, operation range. Results: 30 cases of traumatic patients were 20 cases of closed liver injury and 10 cases of open injury of the liver. 21 cases of patients with preoperative three-dimensional reconstruction model showed the intrahepatic vascular injury, need operation, the preoperative 3D reconstruction of consensus was found in operation. 9 cases of preoperative three-dimensional reconstruction model did not show the intrahepatic vascular injury, conservative treatment for patients with successful. All 30 patients recovered and were discharged from hospital. Conclusion: Abdominal medical image visualization system (MI-3DVS) 3D data can be rapid and efficient completion of the liver of 64 row spiral CT program segmentation, 3D reconstruction, 3D image can completed reflection the liver trauma, it makes doctors have a more comprehensive understanding and diagnosis before the operation, make the operation more precise, so that patients receive timely treatment correctly, abdominal medical image system has a good applied future in the diagnosis and treatment of liver trauma.
EP01D-033 ROBOTIC HEPATOBILIARY AND PANCREATIC SURGERY: INITIAL EXPERIENCE FROM A UK CENTRE P. Prasad, R. Marudanayagam and R. Sutcliffe Liver Unit, University Hospital Birmingham NHS Foundation Trust, United Kingdom Introduction: Robot-assisted surgery has potential advantages over conventional laparoscopy, but there is limited evidence to support its role in complex HPB procedures. The aim of this study was to evaluate our initial experience of robotic HPB surgery, including an economic evaluation of robotic (RLR) compared to open liver resection (OLR). Methods: Two consultant surgeons with experience in laparoscopic HPB surgery undertook structured training supported by Intuitive SurgicalÒ. All procedures were completed using the Da VinciÒ Si system (November 2014eAugust 2015). Clinical, operative and postoperative data were collected prospectively. Procedural
and hospitalization costs were compared between RLR and OLR. Results: 13 procedures were completed: cholecystectomy (3), hepatectomy (7), distal pancreatectomy (1) and choledochal cyst excision (2). There were 3 (grade III) complications after RLR (haematoma 2, bile leak 1), no conversions and zero mortality. Hospital stay after RLR was 4 days. Overall, RLR cost £233 more than OLR. Conclusions: In our experience, the robotic platform facilitates precise dissection in selected HPB procedures. For liver resection, the added cost of robotic instruments is almost negated by reduced hospitalization. However, the morbidity after robotic liver resection is a potential concern and may reflect the limited range of instruments available for transection.
EP01D-034 ALPPS: PROLONGATION OF “SPLIT TO RESECTION” INTERVAL LEADS TO ADJUSTMENTS OF THE THERAPEUTIC STRATEGY IN 1/3 OF THE CASES M. R. Schön, K. Kouladouros, C. Justinger, D. Gärtner and A. Schöttler Department of Surgery, Klinikum Karlsruhe, Germany Introduction: ALPPS-induced liver regeneration has been reported to be a catalyst of growth for preexisting, yet initially not detectable lesions in the future liver remnant (FLR). Our hypothesis is that a prolonged split-to-resection interval is a diagnostic window for detection of such lesions, thus allowing for adjustment of the therapeutic strategy. Materials and methods: Between 2011 and 2015 we applied the ALPPS Procedure on 12 patients with bilateral hepatic tumors, initially inoperable due to insufficient FLR. Results: All patients underwent a resection of metastases in the left lobe and in-situ split with ligation of the right portal vein. The mean interval between the two operations was 47 days. By the end of this interval 1 patient had developed a new metastasis in Segment 1, which was additionally resected at the second step. In 3 patients multiple new metastases were detected in the FLR. By lack of oncologic benefit no extended resection was performed; instead palliative chemotherapy was initiated immediately. 8 patients underwent an extended resection as planned. Conclusions: The prolonged split-to-resection interval allowed for a change of therapeutic strategy in 1/3 of the patients due to newly detected metastases in the FLR.
EP01D-035 LAPAROSCOPIC-ASSISTED LIVER RESECTIONS (LALR): A SAFE AND FEASIBLE STRATEGY OF MINIMALLY INVASIVE LIVER SURGERY APPLIED TO DIFFICULT RESECTIONS J. Kruger, F. Coelho, V. Jeismann, G. Fonseca, R. Araujo and P. Herman Liver Surgery Unit, Hospital das Clinicas, University of Sao Paulo, Brazil
HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
EP01D-032 APPLICATION OF MEDICAL IMAGE THREE-DIMENSIONAL VISUALIZATION SYSTEM (MI-3DVS) SYSTEM IN THE DIAGNOSIS AND TREATMENT OF LIVER TRAUMA C. -H. Fang Department of Hepatobiliary Surgery, ZhuJiang Hospital of Southern Medical University, China Introduction: This study was use MI-3DVS system reconstruction 30 cases of hepatic trauma patients, observation of three-dimensional imaging features of liver trauma. Methods: Application of MI-3DVS system for 3D reconstruction of patients with liver trauma, the trauma site, nature, scope by three-dimensional reconstruction, if the patients need for operation, in comparison with preoperative 3D reconstruction, can help physicians decide the size of operation mode, operation range. Results: 30 cases of traumatic patients were 20 cases of closed liver injury and 10 cases of open injury of the liver. 21 cases of patients with preoperative three-dimensional reconstruction model showed the intrahepatic vascular injury, need operation, the preoperative 3D reconstruction of consensus was found in operation. 9 cases of preoperative three-dimensional reconstruction model did not show the intrahepatic vascular injury, conservative treatment for patients with successful. All 30 patients recovered and were discharged from hospital. Conclusion: Abdominal medical image visualization system (MI-3DVS) 3D data can be rapid and efficient completion of the liver of 64 row spiral CT program segmentation, 3D reconstruction, 3D image can completed reflection the liver trauma, it makes doctors have a more comprehensive understanding and diagnosis before the operation, make the operation more precise, so that patients receive timely treatment correctly, abdominal medical image system has a good applied future in the diagnosis and treatment of liver trauma.
EP01D-033 ROBOTIC HEPATOBILIARY AND PANCREATIC SURGERY: INITIAL EXPERIENCE FROM A UK CENTRE P. Prasad, R. Marudanayagam and R. Sutcliffe Liver Unit, University Hospital Birmingham NHS Foundation Trust, United Kingdom Introduction: Robot-assisted surgery has potential advantages over conventional laparoscopy, but there is limited evidence to support its role in complex HPB procedures. The aim of this study was to evaluate our initial experience of robotic HPB surgery, including an economic evaluation of robotic (RLR) compared to open liver resection (OLR). Methods: Two consultant surgeons with experience in laparoscopic HPB surgery undertook structured training supported by Intuitive SurgicalÒ. All procedures were completed using the Da VinciÒ Si system (November 2014eAugust 2015). Clinical, operative and postoperative data were collected prospectively. Procedural
and hospitalization costs were compared between RLR and OLR. Results: 13 procedures were completed: cholecystectomy (3), hepatectomy (7), distal pancreatectomy (1) and choledochal cyst excision (2). There were 3 (grade III) complications after RLR (haematoma 2, bile leak 1), no conversions and zero mortality. Hospital stay after RLR was 4 days. Overall, RLR cost £233 more than OLR. Conclusions: In our experience, the robotic platform facilitates precise dissection in selected HPB procedures. For liver resection, the added cost of robotic instruments is almost negated by reduced hospitalization. However, the morbidity after robotic liver resection is a potential concern and may reflect the limited range of instruments available for transection.
EP01D-034 ALPPS: PROLONGATION OF “SPLIT TO RESECTION” INTERVAL LEADS TO ADJUSTMENTS OF THE THERAPEUTIC STRATEGY IN 1/3 OF THE CASES M. R. Schön, K. Kouladouros, C. Justinger, D. Gärtner and A. Schöttler Department of Surgery, Klinikum Karlsruhe, Germany Introduction: ALPPS-induced liver regeneration has been reported to be a catalyst of growth for preexisting, yet initially not detectable lesions in the future liver remnant (FLR). Our hypothesis is that a prolonged split-to-resection interval is a diagnostic window for detection of such lesions, thus allowing for adjustment of the therapeutic strategy. Materials and methods: Between 2011 and 2015 we applied the ALPPS Procedure on 12 patients with bilateral hepatic tumors, initially inoperable due to insufficient FLR. Results: All patients underwent a resection of metastases in the left lobe and in-situ split with ligation of the right portal vein. The mean interval between the two operations was 47 days. By the end of this interval 1 patient had developed a new metastasis in Segment 1, which was additionally resected at the second step. In 3 patients multiple new metastases were detected in the FLR. By lack of oncologic benefit no extended resection was performed; instead palliative chemotherapy was initiated immediately. 8 patients underwent an extended resection as planned. Conclusions: The prolonged split-to-resection interval allowed for a change of therapeutic strategy in 1/3 of the patients due to newly detected metastases in the FLR.
EP01D-035 LAPAROSCOPIC-ASSISTED LIVER RESECTIONS (LALR): A SAFE AND FEASIBLE STRATEGY OF MINIMALLY INVASIVE LIVER SURGERY APPLIED TO DIFFICULT RESECTIONS J. Kruger, F. Coelho, V. Jeismann, G. Fonseca, R. Araujo and P. Herman Liver Surgery Unit, Hospital das Clinicas, University of Sao Paulo, Brazil
HPB 2016, 18 (S1), e1ee384