SERVICE OF GENERAL AND DIGESTIVE SURGERY PERFORMED HMS, FOR THE FIRST TIME IN SPAIN, AN ASSISTED BY WAY right hepatectomy ROBOTICS
The intervention carried out in HM University Sanchinarro (HMS) is one of the few in the world made so far
• With this new milestone, HMS, who had already made six types of liver resections children with the help of robotic support, it ranks among the top ten in the world rankings most experienced centers in this complex surgical field
• The robotic surgery, because it provides three-dimensional visualization and the use of articulated instruments incorporating reduces the limitations of laparoscopic surgery, and allows for radical surgery with less risk and postoperative comfort
• right hepatectomy assisted via robotic HMS has been realized in the wide experience in liver surgery and robotic surgery having the hospital, a double skill possess few surgical groups worldwide.
• The intervention and postoperative evolved without any major alterations, and the result was entirely satisfactory. The patient was discharged after 14 days of operation, and after two months of evolution, is in excellent clinical condition without detectable liver tumor
• Since 2010 HM hospitals acquired the Da Vinci surgical robot, especially since he launched the first Chair of Robotic Surgery Abdominal Oncology of Spain, the group has a clear commitment in this direction, and the experience is qualitatively pioneer and national leader in what relates to this specialty
Madrid, January 24, 2013. The Department of General Surgery and Digestive HM University Sanchinarro (HMS) recently conducted an assisted right hepatectomy via robotics, which is the first operation of its kind to be conducted in Spain and one of the few performed worldwide to date since the 217 liver resections carried out worldwide until last December, only 51 were right hepatectomy and therefore had had similar characteristics to that made in HMS.
With this new assistance and technological milestone service directed by Dr. Emilio Vicente and Yolanda Quijano, HMS, already six different types of liver resections children with the help of robotic support, "appears today in the ninth previously made since the world rankings most experienced centers in this complex surgical field "in the words of the experts.
The anatomical liver resections are performed in an almost universally open surgery, with excellent results are obtained. For its realization requires large incisions through which an excellent surgical field is obtained but logically is also associated with a non-negligible morbidity and, in general, greater discomfort for the patient and slow post-operative recovery.
The alternative to this approach is the realization of resection by minimally invasive surgery, a concept in which laparoscopic surgery has been considered until now as the only option. However, through it it is difficult to reproduce the surgical maneuvers to be carried out in the open, such as clamping the hilar pedicle liver transection, controlling bleeding and reconstruction of the bile duct if necessary surgery. This difficulty becomes even more evident in lobar resections anatomical, especially in the right hepatectomy, the trisegmentectomías or lesions located in the posterior segments of the liver.
It is in this scenario where "robotic surgery, thanks to the three-dimensional vision offered and the use of articulated instruments incorporating, helps reduce the limitations of laparoscopic surgery, which can make radical surgery with less risk and more comfort the patient postoperatively to "explain the doctors.
In this respect, Vicente and Quijano said the right hepatectomy has been accomplished in HMS because the hospital has extensive experience in liver surgery and robotic surgery, double skill that is key to addressing this type of intervention and having very few surgical groups in the world. "Our surgical team has extensive experience in this type of surgery they assure not only considered conventional procedures such as lobectomy, segmentectomy secorectomías or liver, but also in more complex techniques such as extracorporeal liver surgery, liver resection surgery associated vascular or hepatic bipartition in situ as a new modality for addressing bilobar metastatic disease, etc ".
Satisfactory results of the intervention
In particular, the case of right hepatectomy robotic assisted surgery was performed on a patient suffering from a liver metastatic colorectal origin conglomerate located in the central and posterior part of the right lobe of the liver. They claim those responsible for the Department of General and Digestive Surgery at HMS, after receiving various chemotherapy protocols, and in the presence of a moderate response, the surgical approach, treatment of choice for this type of pathology with which said, Despite being a widespread disease, excellent results in terms of prolonged survival.
Thanks to the use of robotic surgery, required surgical steps were made in this surgery: Dissection of the vascular-biliary structures of the hepato-duodenal ligament (hepatic artery, portal vein and right biliary tract), liver mobilization and dissection of the vein retrohepatic inferior vena cava in the sector and, eventually, liver transection.
All these surgical steps, regardless of the approach used, often complex, since it is performed on vascular structures of great importance to the organism, so that the increased risk in its realization is bleeding. However, as experts say, in this case, "the Robotic Holder allowed excellent visualization, proper dissection of vascular structures and excellent control of bleeding points during the section of the liver."
And postoperative intervention, which fell more direct part in the surgical group, anesthetic and then the Intensive Care Unit, with the support of the various services and HMS health workers involved in varying degrees in its implementation, developed "without notable alterations" and the result was "fully satisfactory", as it is termed by doctors Vincent and Quijano. Moreover, the patient was discharged after 14 days of operation and two months later is "disease-free and with excellent clinical situation", specifying only the "standard control metastatic disease liver from colorectal cancer, regardless technical and / or surgical approach used, "they add.
Liver resections of peripheral lesions, or even simpler liver resections had already been made in the HMS Digestive and General Surgery with excellent results in terms of lower consumption of blood, decreased postoperative morbidity and reduced postoperative stay .
A promising future
Which, in the opinion of those responsible for that service makes the difference it is that "the important step to the realization of a right hepatectomy with robotic support in our hospital can be optimistic about the future of this technique in patients requiring resections complex anatomical liver ". "HMS is possibly one of the Spanish centers more hepato-biliary-pancreatic surgery performed in cancer -continúan-, so the future of this technique is very promising."
And, since HM hospitals in 2010 acquired the Da Vinci surgical robot and installed in HMS, especially since it launched the first Chair of Robotic Surgery Abdominal Oncology of Spain, the group has a clear commitment in this direction, and accumulated experience in this uptime in qualitative terms is a pioneer and national leader, being the most important at European level in the specific field of tumor pathology of the liver, biliary tract and pancreas, according to doctors.
In this context, say Quijano Vincent and minimally invasive surgery, and more specifically the one performed with robotic support, "will play in the future an important role in very specific centers of the world where extensive experience in robotic surgery and associate liver surgery, as it will perform, in selected patients, radical surgery with great confidence that will be associated with a lower consumption of blood, better postoperative recovery and shorter hospital stay. " "Given the nature of the indications for their realization in cancer, these are momentous issues facing the beginning of a rapid postoperative chemotherapy when necessary use it to keep control of the process neoformative" they conclude.