Abstract
Robotic liver resection is a new promising minimally invasive surgical technique not yet validated by level I evidence. During recent years, the application of the laparoscopic approach to liver resection has grown less than other abdominal specialties due to the intrinsic limitations of laparoscopic instruments. Robotics can overcome these limitations above all for complex operations. A review of the literature on major hepatic surgery was conducted on PubMed using selected keywords. Two hundred and thirty-five patients in 17 series were analysed and outcomes such as operative time, estimated blood loss, length of hospital stay, complications, conversion rate, and costs were described. The most commonly performed procedures were wedge resection and segmentectomy, but the predominance of major hepatectomies performed with robotic surgery is likely due to the superior control achieved by the robotic system.The conversion and complication rates were 4.2% and 13.4%, respectively. Intracavitary fluid collections and bile leaks were the most frequently occurring morbidities. The mean operation time was 285 min. The mean intraoperative blood loss was 50–280 mL. The mean postoperative hospital stay was four to seven days. Overall survival and long-term outcomes were not reported. Robotic liver surgery in Italy has become a clinical reality that is gaining increasing acceptance; a survey was carried out on robotic surgery, which showed that it is perceived as a significant advantage for operators and a consistent gain for the patient. More than 100 robotic hepatic resections have been performed in Italy where important robotic training schools are active.Robotic liver surgery is feasible and safe in trained and experienced hands. Further evaluation is required to assess the improvement in outcomes and long-term oncologic follow-up.
Highlights
Robotic liver resection is a new promising minimally invasive surgical technique not yet validated by level I evidence
We summarise the major issues of reported robotic liver resections (RLRs), with emphasis on clinical outcomes, reporting data on the Italian activity of robotic resective surgery of the liver
As presented by Ho CM in his review [41], we summarise in Table 4 the oncological outcomes if reported for HCC and colorectal liver metastasis (CRLM)
Summary
Twenty-five years have passed since the first successful minimally invasive surgical procedure [1] and laparoscopic general surgery has grown exponentially with particular regard to certain pathologies and besides cholecystectomy [2], it is considered to be the gold standard for surgery of the oesophagogastric junction, adrenal glands, distal pancreas, and spleen [3,4,5,6,7,8,9].The expanding role of laparoscopic surgery is closely associated with technological advances, including the advent of flexible fibreoptic instruments and improved laparoscopic haemostatic devices such as clips, endoscopic staplers, and energy-induced forceps (electrical based and ultrasonic based). At the end of 2008, a consensus conference on laparoscopic liver resection (LLR) was held in Louisville, Kentucky [12]. During this conference, the criteria that are best suited for this kind of surgery were defined, including lesions that are solitary, 5 cm or less, located in peripheral segments 3–6. The robotic technique allows improvement over conventional laparoscopy as it mimics the surgeon’s hands to the tip of instruments, which have seven degrees of freedom and can articulate up to 90°. The articulated instruments allow operation with just a shorter learning curve than for complex laparoscopic procedures (involving dissection or reconstruction) [13,14,15,16]
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