Robotic hepatic surgery in malignancy: review of the current literature

Fahrner, René; Rauchfuß, F.; Bauschke, Astrid; Kißler, Hermann; Settmacher, Utz; Zanow, Jürgen

doi:10.1007/s11701-019-00939-w

Cited by 32 publications

(21 citation statements)

References 62 publications

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“…Daskalaki et al [12] indicated the specific results of major and minor resections, showing higher EBL and conversion rate, longer operative time and LOS for major resections: mean EBL 354. 7 Only 10 articles reported data about the use of the Pringle maneuver and the median rate of its application was 23.6% (range 0-55.6). The agreement in the literature on this topic is limited and some authors considered pedicle clamping unnecessary in most cases during RS [13][14][15]36] .…”

Section: Surgery Related Factorsmentioning

confidence: 99%

“…Finally, one of the major drawbacks of RS are costs, limiting its use to selected surgical procedures and few centers. As a minimally invasive approach, RS allows improvement of almost all the parameters of postoperative recovery, such as pain control, oral intake, postoperative morbidity and length of hospital stay [7] . Recently, the Southampton international guidelines, providing indications and limits of liver MIS, advocated RS as a promising, but not yet standardized, approach [8] .…”

Section: Introductionmentioning

confidence: 99%

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Robotic liver surgery: literature review and current evidence

Ruzzenente¹,

Alaimo²,

Conci³

et al. 2020

Mini-invasive Surg

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In the field of minimally invasive surgery, robotic surgery (RS) was introduced to overcome drawbacks in laparoscopic surgery. However, its clinical application in hepatobiliary surgery is not yet standardized. This review analyzed the results of RS to clarify the benefits of robotic liver surgery in comparison with standard laparoscopy. Among 112 publications found in the literature, the 72 most relevant were selected and the following data were extracted: patients characteristics, operative procedures, histopathology, short-term and long-term outcomes, and costs. Twenty-nine articles on robotic liver resections, published in the last five years (2015-2020) and including 1831 patients, were analyzed. Twenty-five comparative studies between robotic and laparoscopic surgery were evaluated to underline the differences in operative outcomes. Eventually, 4 sub-group analyses were conducted on hepatocellular carcinoma, gallbladder cancer, hilar cholangiocarcinoma, and colorectal liver metastases. Almost all the authors reported data on safety, feasibility and oncologic effectiveness of RS reaching comparable results with laparoscopy. However, even if robotic surgery showed longer operative time and higher costs, in selected cases it allowed to increase the rate of minimally invasive approach when compared with laparoscopy. Thus, both open and minimally invasive surgery should be provided in a modern hepatobiliary center, including the robotic approach particularly to complex cases, otherwise very demanding by laparoscopy. In conclusion, different techniques should be tailored to each patient, choosing the minimally invasive approach when possible, enhancing patients’ recovery after surgery, especially in cirrhotic livers and in the context of liver transplantation. Although many centers experienced robotic liver surgery, more and larger studies are necessary to define its real benefits relative to laparoscopy, in order to standardize patient selection criteria and techniques.

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Section: Surgery Related Factorsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robotic liver surgery: literature review and current evidence

Ruzzenente¹,

Alaimo²,

Conci³

et al. 2020

Mini-invasive Surg

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“…Four-arm da Vinci Si enables the surgeon to perform safer resections, reduced bleeding and major dexterity, particularly in hilar time and in vena cava detachment time. One of the major disadvantages of the robot is its cost [88,89].…”

Section: Major Hepatectomiesmentioning

confidence: 99%

“…Robotic liver resection (RLR) allows to go beyond laparoscopic disadvantages, thanks to superior flexibility of its arms. For this reason, RLRs are considered safe, even in deep parenchyma or posterior segment [89]. It is comparable to open approach considering the oncological radicality, but it presents the same advantages of laparoscopy in terms of length of hospital stay and postoperative complications.…”

Section: Limited Hepatectomiesmentioning

confidence: 99%

HCC in Cirrhotic and Non-cirrhotic Liver: Timing to Surgery and Outcome - State of the Art

Brozzetti¹,

Bini²,

D’Alterio³

et al. 2019

Liver Disease and Surgery [Working Title]

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In this chapter we aim at presenting the state of the art in liver surgery. After a brief introduction about natural evolution of hepatocellular carcinoma (HCC) either in cirrhotic or non-cirrhotic patients, this manuscript will focus on planning and timing surgery: CT evaluation of the remnant liver; biopsy and ultrasonography (US) evaluation of liver disease; intraoperative US; surgical techniques, such as major and limited hepatectomies and two-stage hepatectomies, each of them in open or mini-invasive approach; and their possible complications. Follow-up and further interventions during expected recurrences will be highlighted. Our chapter will also treat topics such as patient's quality of life, importance of multidisciplinary evaluation and the role of surgeon in it.

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“…[37] [38] [39]. However, Lafaro et al[38] has recently reported comparative analysis of several high-quality nonrandomized as well as meta-analyses studies.…”

mentioning

confidence: 99%