International experts consensus guidelines on robotic liver resection in 2023

Abstract

The robotic liver resection (RLR) has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system, however, controversies still exist. Based on the foundation of the previous consensus statement, this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice. The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine (EBM). Relevant literature was reviewed and analyzed by the evidence evaluation group. According to the WHO Handbook for Guideline Development, the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022, a total of 14 recommendations were generated. Among them were 8 recommendations formulated by the GRADE method, and the remaining 6 recommendations were formulated based on literature review and experts’ opinion due to insufficient EBM results. This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.

Feasibility and oncologic efficacy of robotic vs. open liver resection for large and huge hepatocellular carcinoma

“…This study indeed provided encouraging results and evidence about a poorly investigated topic 2 . These findings should now be confirmed in the western series and prospectively.…”

Validation of the IWATE Criteria in Robotic-Assisted Liver Resections

“…Nevertheless, further development of the IWATE criteria could be necessary to ensure their applicability in RALR to predict perioperative outcomes. According to the recently published International Expert Consensus on robotic liver resections, a new DSS exclusively for RALR should be established [13].…”

“…RALR provides a greater range of motion, high-resolution 3D visualization, elimination of the surgeon's tremor and improvement of the surgeon's ergonomics [13][14][15]. This results in comparable postoperative outcomes but lower conversion rates and less intraoperative blood loss in comparison to LLRs [13,[16][17][18][19][20][21][22][23].…”

“…Parallel to the establishment of LLR, the implementation of robotic-assisted liver resections (RALRs) has gained more attention and recognition in recent years [10][11][12]. RALR provides a greater range of motion, high-resolution 3D visualization, elimination of the surgeon's tremor and improvement of the surgeon's ergonomics [13][14][15]. This results in comparable postoperative outcomes but lower conversion rates and less intraoperative blood loss in comparison to LLRs [13,[16][17][18][19][20][21][22][23].…”

Prince and princesses: The current status of robotic surgery in surgical oncology

“…However, the challenges of performing laparoscopic hepatectomies (LH) have led to interest in the use of the robot. Positive outcomes from initial experience with robotic hepatectomy (RH) led to the release of the 2023 International Consensus Guidelines in support of the use of the robot to perform most liver surgeries 100 . Without RCTs comparing robotic liver surgery for primary liver cancer to the open or laparoscopic approach, retrospective studies and meta‐analyses shape the current status of robotic liver surgery.…”