Publications by authors named "Ricardo Robles-Campos"
Objective: This study aimed to establish global benchmark outcomes indicators for robotic liver resections (R-LR).
Background: In recent years, minimally invasive liver resections and in particular R-LR has seen an increase in uptake in recent years. Although, benchmark outcomes have been recently established for laparoscopic (L) -LR, this has not been established for R-LR.
Objective: To establish benchmark cutoffs for robotic liver resection (R-LR), encompassing both major and minor resections, and to determine the impact of patient selection on outcomes.
Background: R-LR is a key advancement in minimally invasive liver surgery but lacks standardized benchmarks, especially for minor resections. While guidelines endorse R-LR, its role in optimizing outcomes remains unclear.
Introduction: The Iwate difficulty scoring system (DSS) is one of the most widely validated DSS for laparoscopic liver resection (LLR). However, these studies only validated the 4 difficulty levels and did not validate the 12-point difficulty index of the system. To address current limitations in the studies validating the Iwate difficulty scoring system (DSS), we performed an international multicenter study to validate the Iwate DSS across both its four difficulty levels and 12-point difficulty index.
View Article and Find Full Text PDFMinimally invasive liver surgery has become widely accepted as a safe and effective approach, especially with experienced surgeons. Robotic hepatectomy may offer significant benefits in challenging procedures like caudate lobe resection. The caudate lobe's intricate anatomy and deep-seated location make its resection particularly challenging, with limited reports on minimally invasive techniques.
View Article and Find Full Text PDFBackground: The adoption of robotic techniques in liver surgery introduces significant challenges for their safe integration within hepatobiliary surgery units. This study is designed to investigate the complexities associated with establishing a robotic surgery program.
Methods: Data on robotic hepatobiliary surgeries were prospectively collected from October 2021 to October 2023.
Article Synopsis
- The Barcelona Clinic Liver Cancer (BCLC) staging system is crucial for treating hepatocellular carcinoma (HCC); recent updates allow for BCLC stage B patients to consider liver transplantation, while hepatectomy is now discouraged.
- A systematic review analyzed 31 studies involving 3163 patients to compare survival rates, postoperative complications, and patient selection for liver resection versus transplantation in BCLC stage B patients.
- Results showed that while resection had a 50-month survival and a 15-month recurrence-free period, data on transplantation was limited, with only one study reporting on it, indicating the need for more research in this area.
Article Synopsis
- A study was conducted to compare robotic minor liver resections (RMLR) with laparoscopic minor liver resections (LMLR) in patients undergoing surgery on the anterolateral liver segments.
- The analysis included over 10,000 patients and employed propensity score matching to balance the groups for accuracy in comparisons.
- Results indicated RMLR had benefits like less blood loss, lower major morbidity, and shorter hospital stays than LMLR, although the difference in 30-day readmission rates suggested RMLR may have some drawbacks.
Objective: We analyzed the use of a self-expandable absorbable biliary stent (SEABS) to reduce biliary complications in liver transplant (LT).
Background: Complications related to biliary anastomosis are a still a challenge in LT with a high impact on the patient outcomes and hospital costs.
Methods: This non-randomized prospective study was conducted between July 2019 and September 2023 in adult LT patients with duct-to-duct biliary anastomoses.
Article Synopsis
- The study aimed to create global benchmark outcome indicators for laparoscopic right posterior sectionectomies (L-RPS/H67) to improve surgical standards.
- It analyzed data from 854 patients across 57 centers globally, establishing key performance benchmarks for low-risk cases based on specific outcome indicators.
- The findings set standard benchmarks for metrics like operation time and complication rates, serving as a reference for surgical auditing and improvement.
Article Synopsis
- The study aimed to establish a common language regarding extreme liver surgery to facilitate better comparison of surgical outcomes across different centers.
- A Delphi methodology was used, gathering opinions from 38 expert surgeons, who largely agreed on key definitions related to total vascular occlusion and surgical approaches, achieving consensus on various topics.
- Ultimately, 75% agreed on a definition for extreme liver surgery, highlighting the importance of a unified approach in managing patients with complex liver diseases.
Article Synopsis
- The study investigates the risk factors and outcomes related to open conversion during minimally invasive liver resections (MILR), especially in minor hepatectomies, highlighting its association with inferior results.
- Analysis was conducted on data from over 10,500 patients who underwent laparoscopic or robotic liver resections from 2004 to 2020, identifying key independent predictors for open conversion.
- Results show that patients who required open conversion experienced longer recovery times, increased blood loss, higher complications, and elevated 90-day mortality rates compared to those who had successful minimally invasive surgeries.
Background: In recent years, there has been growing interest in laparoscopic liver resection (LLR) and the audit of the results of surgical procedures. The aim of this study was to define reference values for LLR in segments 7 and 8.
Study Design: Data on LLR in segments 7 and 8 between January 2000 and December 2020 were collected from 19 expert centers.
Impact of neoadjuvant chemotherapy on short-term outcomes after simple and complex minimally invasive minor hepatectomy for colorectal liver metastases: A propensity-score matched and coarsened exact matched study.
Eur J Surg Oncol
June 2024
Article Synopsis
- Minimally invasive liver surgery has become more common over the last 30 years, especially for treating colorectal liver metastases, but the effects of neoadjuvant chemotherapy on surgical outcomes are not well understood.
- A study analyzed a large database of nearly 5,000 patients who underwent minimally invasive liver surgeries to compare outcomes between those who received neoadjuvant chemotherapy and those who did not.
- The results showed that neoadjuvant chemotherapy did not significantly affect the short-term surgical outcomes in patients undergoing these liver procedures.
Correction: Explainable artificial intelligence prediction-based model in laparoscopic liver surgery for segments 7 and 8: an international multicenter study.
Surg Endosc
May 2024
Article Synopsis
- A study was conducted to compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) across various healthcare settings from 2009 to 2021.
- The results showed that RLS had better outcomes in terms of "textbook outcomes," lower blood loss, fewer complications, and shorter operative times compared to LLS after matching patient groups for bias.
- Despite the higher costs generally associated with robotic surgery, this study suggests that RLS may offer specific clinical advantages over LLS in minimally invasive liver procedures.
Textbook outcome in patients with biliary duct injury during cholecystectomy.
J Gastrointest Surg
May 2024
Article Synopsis
- * Data from 808 patients were analyzed, revealing that 46.9% achieved TO, with significantly lower overall complications (11.9% vs. 86%) compared to those who did not achieve TO, leading to increased major complications and mortality rates.
- * Factors enhancing the likelihood of achieving TO include treatment at specialized centers, initial surgery transfer, and conservative or surgical management, highlighting the importance of effective perioperative care in managing BDI.
Multimodal prehabilitation program in patients with resectable perihilar cholangiocarcinoma: keypoints for an implementation protocol and literature review.
Langenbecks Arch Surg
February 2024
Background: Postoperative complications after perihilar cholangiocarcinoma surgical procedure are still very high. The implementation of a multimodal prehabilitation program could improve these outcomes. Based on our experience and that of the literature in hepatobiliary and pancreatic surgery, we propose a protocol to promote its implementation.
View Article and Find Full Text PDFBackground: Artificial intelligence (AI) is becoming more useful as a decision-making and outcomes predictor tool. We have developed AI models to predict surgical complexity and the postoperative course in laparoscopic liver surgery for segments 7 and 8.
Methods: We included patients with lesions located in segments 7 and 8 operated by minimally invasive liver surgery from an international multi-institutional database.