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Comparative Study
. 2017 May;19(5):429-435.
doi: 10.1016/j.hpb.2016.12.015. Epub 2017 Jan 26.

Robotic hepatic arterial infusion pump placement

Motaz Qadan  1 , Michael I D'Angelica  2 , Nancy E Kemeny  3 , Andrea Cercek  3 , T Peter Kingham  4
Affiliations
Comparative Study

Robotic hepatic arterial infusion pump placement

Motaz Qadan et al. HPB (Oxford). 2017 May.

Abstract

Background: Hepatic artery infusion pump (HAIP) placement is associated with improved outcomes in the treatment of colorectal liver metastases (CRLM). In this study, we examined outcomes following robotic HAIP placement, which were compared with open and laparoscopic placement.

Methods: A retrospective review of HAIP placements by 2 surgeons at a single institution was carried out. All statistical tests were 2-sided and p < 0.05 was considered significant.

Results: There were a total of 53 open HAIP cases, 21 laparoscopic cases, and 24 robotic cases. Robotic HAIP placement was associated with a significantly lower conversion rate to open operation than laparoscopic pump placement (17 vs. 67%; p = 0.0009). When cases with concomitant resections were excluded, there was a trend towards shorter median length of hospital stay with robotic pump placement compared with open and laparoscopic placement (4 vs. 5 vs. 5 days, respectively; p = 0.09). Complication rates were equivalent among the 3 groups when concomitant resections were excluded.

Conclusion: Robotic HAIP placement is a safe minimally-invasive procedure that is associated with a significantly lower conversion rate to open operation compared with laparoscopic placement and a trend towards shorter hospitalization compared with open placement.

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Conflict of interest statement

The authors have no conflicts of interest, financial or otherwise, to disclose.

Figures

Figure 1
Figure 1
Figure 1a. Hepatic arterial anatomy in preparation for placement of the hepatic arterial infusion pump catheter. Figure 1b. Precise placement of the hepatic arterial infusion pump catheter into the gastroduodenal artery at the confluence of the common hepatic artery.
Figure 1
Figure 1
Figure 1a. Hepatic arterial anatomy in preparation for placement of the hepatic arterial infusion pump catheter. Figure 1b. Precise placement of the hepatic arterial infusion pump catheter into the gastroduodenal artery at the confluence of the common hepatic artery.
Figure 2
Figure 2
Figure 2a. Still image during robotic hepatic arterial infusion pump placement taken at the point of making an arteriotomy in the gastroduodenal artery. Figure 2b. Still image during robotic hepatic arterial infusion pump placement taken during securing of the catheter in the in the gastroduodenal artery, which is placed at the confluence of the common hepatic artery. Figure 2c. Methylene blue injection that is instilled to demonstrate the absence of extrahepatic perfusion in the duodenum, distal stomach, and adjacent lymph nodes, in addition to confirming hepatic cross perfusion. Figure 2d. Port placement in relation to subcutaneous pocket created for hepatic arterial infusion pump.
Figure 2
Figure 2
Figure 2a. Still image during robotic hepatic arterial infusion pump placement taken at the point of making an arteriotomy in the gastroduodenal artery. Figure 2b. Still image during robotic hepatic arterial infusion pump placement taken during securing of the catheter in the in the gastroduodenal artery, which is placed at the confluence of the common hepatic artery. Figure 2c. Methylene blue injection that is instilled to demonstrate the absence of extrahepatic perfusion in the duodenum, distal stomach, and adjacent lymph nodes, in addition to confirming hepatic cross perfusion. Figure 2d. Port placement in relation to subcutaneous pocket created for hepatic arterial infusion pump.
Figure 2
Figure 2
Figure 2a. Still image during robotic hepatic arterial infusion pump placement taken at the point of making an arteriotomy in the gastroduodenal artery. Figure 2b. Still image during robotic hepatic arterial infusion pump placement taken during securing of the catheter in the in the gastroduodenal artery, which is placed at the confluence of the common hepatic artery. Figure 2c. Methylene blue injection that is instilled to demonstrate the absence of extrahepatic perfusion in the duodenum, distal stomach, and adjacent lymph nodes, in addition to confirming hepatic cross perfusion. Figure 2d. Port placement in relation to subcutaneous pocket created for hepatic arterial infusion pump.
Figure 2
Figure 2
Figure 2a. Still image during robotic hepatic arterial infusion pump placement taken at the point of making an arteriotomy in the gastroduodenal artery. Figure 2b. Still image during robotic hepatic arterial infusion pump placement taken during securing of the catheter in the in the gastroduodenal artery, which is placed at the confluence of the common hepatic artery. Figure 2c. Methylene blue injection that is instilled to demonstrate the absence of extrahepatic perfusion in the duodenum, distal stomach, and adjacent lymph nodes, in addition to confirming hepatic cross perfusion. Figure 2d. Port placement in relation to subcutaneous pocket created for hepatic arterial infusion pump.
See this image and copyright information in PMC

References

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