12 - Robotic Liver Surgery: Shortcomings of the Status Quo

Abstract

Robotic surgery has emerged as a promising minimally invasive surgical technique, with the ability to perform complex hepatobiliary surgeries and achieve outcomes similar to open surgery, but with the advantages of a minimally invasive approach. Recent advances in computer-assisted image-guided surgery are proposed to overcome some of the associated limitations of robotic surgery by preoperatively planning the surgical strategy with a patient-specific virtual resection plan, which can be directly transferred to the operating room in an augmented reality setup. Using new technologies, we could theoretically improve the preoperative planning, enhance the surgeon’s skill, and simplify complex procedures. Specifically, using an optical tracking system, calibrated on the patient, we used images-overlay navigation for the location of the lesions during robotic liver resections. Based on our experience, we suggest that robotic image guidance can improve the surgeon’s orientation during the operation, increasing the accuracy of tumor resection. The indications for robotic-assisted liver resection will increase in the coming years. This chapter reviews the recent development of robotic hepatic surgery, discussing its advantages and disadvantages in daily practice. The most common surgical procedures are described and, finally, the evolution of robotic surgery, one of the hottest fields in medical technology, is detailed.