Conversion in Minimally Invasive Liver Surgery: The Impact of Conversion Urgency and Surgical Approach.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Pilz da Cunha Gabriela, Aghayan Davit, Cipriani Federica, Chua Darren W, Morrison-Jones Victoria, Lanari Jacopo, de Meyere Celine, Wei Kongyuan, Tzedakis Stylianos, Martinie John, Bordom Daniel Osei, Adel Soufyan El, Crespo Kaitlyn, Magistri Paolo, Russolillo Nadia, Conci Simone, Cacciaguerra Andrea Benedetti, D'Souza Daniel, Zozaya Gabriel, Caula Cèlia, Rehman Shafiq, Fretland Åsmund Avdem, Koh Ye-Xin, Besselinkz Marc G, van Dieren Susan, Geller David, Campos Ricardo Robles, Croner Roland S, Jovine Elio, Efanov Mikhail, Alseidi Adnan, Memeo Riccardo, Dagher Ibrahim, Giuliante Felice, Sparrelid Ernesto, Ahmad Jawad, Gallagher Tom, Schmelzle Moritz, White Steven, Ben Santi Lopez, Rotellar Fernando, Serrano Pablo E, Vivarelli Marco, Ruzzenente Andrea, Ferrero Alessandro, Di Benedetto Fabrizio, Sucandy Iswanto, Sutcliffe Robert P, Vrochides Dionisios, Fuks David, Liu Rong, D'Hondt Mathieu, Cillo Umberto, Primrose John N, Goh Brian K P, Ratti Francesca, Edwin Bjørn, Abu Hilal Mohammad, Swijnenburg Rutger-Jan, International Consortium on Minimally Invasive Liver Surgery (IMILS)
Аннотация
PATIENTS AND METHODS: Data from 34 international centers of patients undergoing converted MILS procedures (stratified for conversion urgency) were retrospectively compared with patients who underwent elective open liver surgery using propensity score matching. Additionally, RLR and LLR conversions were compared. Conversion risk factors were identified using multivariable logistic regression in RLR and LLR separately.
RESULTS: Among 10,548 MILS procedures (n = 1626 RLR and n = 8922 LLR), 719 (6.8%) were converted. Both emergency (n = 226) and elective (n = 472) conversions were associated with longer operative time and more Pringle use compared with open surgery. Emergency conversions additionally showed higher blood loss, transfusion rates, severe morbidity, and even mortality. Matched analysis of 40 pairs of RLR and LLR conversions identified no significant differences in perioperative outcomes, although mortality following RLR conversion was remarkably high (7.7%). RLR conversion risk factors were bilobar disease and anatomically major resection; whereas LLR risk factors included cirrhosis, history of previous liver surgery, tumor size, technically complex, and anatomically major resection.
CONCLUSIONS: Emergency conversions in MILS are associated with worse outcomes, whereas elective conversions appear safe, highlighting the importance of timely, controlled conversion. Further investigation into the safety of robotic conversions is warranted.