Abstract:
Objective To investigate the application value of Da Vinci robotic surgical
system in radical resection of perihilar cholangiocarcinoma (pCCA).
Methods The retrospective
and descrip-tive study was conducted. The clinicopathological data of 10 patients undergoing Da
Vinci robotic radical resetion of pCCA in Union Hospital, Tongji Medical College, Huazhong University
of Science and Technology from September 2018 to March 2021 were collected. There were 6 males
and 4 females, aged (58±7)years. Observtaion indicators: (1) surgical situations; (2) postoperative
situations; (3) follow-up. The patients were followed up by telephone interview and outpatient service to detect survival of patients and tumor recurrence up to June 2021. Measurement data with
normal distribution were expressed as Mean±SD, and measurement data with skewed distribution were represented as M(range). Count data were represented as absolute numbers.
Results(1) Surgical situations: 10 patients underwent Da Vinci robotic radical resection of pCCA successfully, without conversion to laparotomy or intraoperative blood transfusion. The operation
time of 10 patients was (465±87)minutes, and the volume of intraoperative blood loss was (167±
81)mL. Of the 10 patients, 1 case of Bismuth type Ⅲ b had a positive surgical margin and the
remaining 9 cases had R0 resection. (2) Postoperative situations: the time to gastric tube extraction
was (2.3±1.9)days, and the duration of postoperative hospital stay of the 10 patients was (19.9±
9.0)days. Among the 10 patients, there was no second operation or perioperative death. Of the
10 patients, 6 cases had perioperative complications, including 5 cases wth pleural effusion,
3 cases with peritoneal effusion, and 1 case with intestinal obstruction, some patients had multiple
complications. After symptomatic conservative treatment, pleural effusion and peritoneal effusion
disappeared and intestinal obstruction was improved. None of the 10 patients had serious complications such as bleeding, biliary fistula or intestinal fistula. (3) Follow-up: 10 patients were followed
up for 3?20 months, with a median follow-up time of 11 months. During the follow-up, 3 of 10 patients
had tumor recurrence which occurred in intrahepatic bile duct of residual liver, and no implantation
metastasis was found in the rest of abdominal cavity. Of the 7 unrecurrent patients, 1 case died of
gastrointestinal bleeding and multiple organ failure. Nine of 10 patients survived well.
ConclusionThe Da Vinci robotic surgical system used for radical operation of pCCA is feasible.