Robotic liver resection: Hurdles and beyond

Benedetto, Fabrizio Di; Petrowsky, Henrik; Magistri, Paolo; Halazun, Karim J.

doi:10.1016/j.ijsu.2020.05.070

Cited by 44 publications

(24 citation statements)

References 50 publications

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“…In this setting, the robotic approach may represent a novel player thanks to its additional advantages over standard laparoscopy. A magnified stable view and increased dexterity allow for a more precise parenchymal transection, reducing the risk of postoperative morbidity [15]. Moreover, even difficult segments [16,17] can be safely approached with the robotic approach, as demonstrated in our cohort that included three segment VIII and one segment VII resections.…”

Section: Discussionmentioning

confidence: 67%

Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Magistri

Catellani

Frassoni

et al. 2020

Cancers

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Background: The correct approach for early hepatocellular carcinoma (HCC) is debatable, since multiple options are currently available. Percutaneous ablation (PA) is associated in some series to reduced morbidity compared to liver resection (LR); therefore, minimally invasive surgery may play a significant role in this setting. Methods: All consecutive patients treated by robotic liver resection (RLR) or PA between January 2014 and October 2019 for a newly diagnosed single HCC, less than 3 cm in size (very early/early stages according to the Barcelona Clinic Liver Cancer (BCLC)) on chronic liver disease or liver cirrhosis, were enrolled in this retrospective study. The aim of this study was to compare short- and long-term outcomes to define the best approach in this specific cohort. Results: 60 patients fulfilled the inclusion criteria: 24 RLR and 36 PA. The two populations were homogeneous in terms of baseline characteristics. There were no statistically significant differences regarding the incidence of postoperative morbidity (RLR 38% vs. PA 19%, p = 0.15). The cumulative incidence of recurrence (CIR) was significantly higher in patients who underwent PA, with the one, two, and three years of CIR being 42%, 69%, and 73% in the PA group and 17%, 27%, and 27% in the RLR group, respectively. Conclusions: RLR provides a significantly higher potential of cure and tumor-related free survival in cases of newly diagnosed single HCCs smaller than 3 cm. Therefore, it can be considered as a first-line approach for the treatment of patients with those characteristics in high-volume centers with extensive experience in the field of hepatobiliary surgery and minimally invasive approaches.

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Section: Discussionmentioning

confidence: 67%

Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Magistri

Catellani

Frassoni

et al. 2020

Cancers

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“…Regarding indications for robotic liver surgery, it thus seems to be clear that oncological outcomes are comparable to those of open and laparoscopic approaches for HCC and CCC [ 12 , 50 , 51 ].…”

Section: Indication/contraindicationmentioning

confidence: 99%

“…Nevertheless, there is a growing awareness of the fact, that the robotic learning curve in liver surgery is faster than the laparoscopic one and that robotic surgery may allow optimized access to difficult liver segments [ 51 ].…”

Section: Learning Curvementioning

confidence: 99%

Robotic-Assisted Surgery for Primary Hepatobiliary Tumors—Possibilities and Limitations

Spiegelberg

Iken

Fichtner‐Feigl

2022

Cancers

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Hepatocellular and cholangiocellular carcinoma are fatal primary hepatic tumors demanding extensive liver resection. Liver surgery is technically challenging due to the complex liver anatomy, with an intensive and variant vascular and biliary system. Therefore, major hepatectomies in particular are often performed by open resection and minor hepatectomies are often performed minimally invasively. More centers have adopted robotic-assisted surgery, intending to improve the laparoscopic surgical limits, as it offers some technical benefits such as seven degrees of freedom and 3D visualization. The da Vinci® Surgical System has dominated the surgical robot market since 2000 and has shown surgical feasibility, but there is still much controversy about its economic benefits and real benefits for the patient over the gold standard. The currently available retrospective case studies are difficult to compare, and larger, prospective studies and randomized trials are still urgently missing. Therefore, here we summarize the technical, surgical, and economic outcomes of robotic versus open and laparoscopic hepatectomies for primary liver tumors found in the latest literature reviews and meta-analyses. We conclude that complex robotic liver resections (RLR) are safe and feasible after the steep learning curve of the surgical team has plateaued. The financial burden is lower in high volume centers and is expected to decrease soon as new surgical systems will enter the market.

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“…These technical advantages allowed the surgeon to emulate the surgical maneuvers of ODH within the enclosed peritoneal cavity. Rapid, atraumatic liver mobilization, meticulous hilar and short retrohepatic vein dissection, and hilar plate visualization and division are all undeniably superior with the robotic platform [33][34][35][36] (Figure 1).…”

Section: What Are the Advantag E S Of The Roboti C Pl Atform Over Con...mentioning

confidence: 99%

Robotic donor hepatectomy: A major breakthrough in living donor liver transplantation

Bröering¹,

Sturdevant²,

Zidan³

2022

American Journal of Transplantation

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Living donation in many countries is the main resource of organs. Healthy, volunteering individuals deserve the highest safety standards possible in addition to the least invasive technique to procure the organs. Since the introduction of living donor liver transplantation, many efforts have been made to minimize the surgical trauma inherent to living donor surgery. The journey started with a large Mercedes incision and evolved to reverse L‐shaped and small upper midline incisions before the introduction of minimally invasive laparoscopic techniques originated. The technical difficulties of the laparoscopic approach due to suboptimal instrumentation, challenging ergonomics, and the long learning curve limited the application of the fully laparoscopic approach to a few centers. The recent introduction of the robotic platform with its superb optical system and advanced instruments allows for the first time, a genuine emulation of open donor surgery in a closed abdomen, thus allowing all liver donors to benefit from minimally invasive surgery (better cosmesis, less pain and morbidity, and better quality of life) without compromising donor safety. This attribute in combination with the ubiquitous presence of the robot in major transplant centers may well lead to the desired endpoint of this technology, namely, the widespread dissemination of minimally invasive donor surgery.

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Robotic liver resection: Hurdles and beyond

Cited by 44 publications

References 50 publications

Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Robotic Liver Resection Versus Percutaneous Ablation for Early HCC: Short- and Long-Term Results

Robotic-Assisted Surgery for Primary Hepatobiliary Tumors—Possibilities and Limitations

Robotic donor hepatectomy: A major breakthrough in living donor liver transplantation

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