Setting up a robotic hepatectomy program: a Western-European experience and perspective

Abstract

Currently the majority of liver resections are performed via open resection. Nevertheless, minimally invasive liver surgery is gaining ground and conventional laparoscopy has proven to be beneficial in different fields of liver surgery compared to open resections. Still, conventional laparoscopy has a few downsides, from which straight instruments, 2-dimensional view and awkward ergonomics are the most obvious. The robotic surgical system is developed to overcome these limitations. It offers several advantages over conventional laparoscopy to optimize conditions in minimally invasive surgery: instruments are wristed with a wide range of motion and the view is 3-dimensional and magnified. With instruments with a greater range of motion than in laparoscopic surgery, the use of a robotic system potentially broadens indications for minimally invasive liver resection. Here, we discuss the steps of setting up a robotic hepatectomy program against the background of the initial experience at our institution.

Robotic fenestration of massive liver cysts using EndoWrist technology

“…Contrary to robotic liver resections, reports on robotic deroofing of liver cysts are extremely limited. 22,23 In our experience, robotic deroofing has been shown to be safe and feasible for various cyst locations, and to our knowledge, this is the largest reported series to date.…”

Laparoscopic liver resection: a review of current indications and surgical techniques

“…It was applied for liver surgery in early 2010s, the initial experiences showed that robotic system can be used not only minor but also major liver resection (109,110). Recent reviews summarized the half-decade development of robotic liver surgery (111,112). Not limited to similar efficiency compared to conventional laparoscopic approach, its unique advantages of facilitating suturing under laparoscope allow it to provide more possibilities in the future.…”

Minimally invasive liver resection: has the time come to consider robotics a valid assistance?

“…In fact, some papers showed that parenchymal-sparing resection of the postero-superior segments was performed more often by a robotic approach in comparison with laparoscopic procedures, which commonly extend to a major resection (11). An additional advantage is less surgeon fatigue, especially in longer procedures (5).…”

“…Therefore, the worldwide rise of audited national registers, national survey inquiries (6) and coordinated multi-center programs (3,5) on the appropriateness of MILR and the diffusion of robotic liver resection, especially given the difficulty in establishing randomized controlled trials, is highly desirable.…”