Abstract
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.
Highlights
Since its introduction, robotic surgery (RS) has received great interest from scientific societies
Further reports were retrieved from those listed in the articles’ references and from the manual search on specific additional topics, such as robotic surgery for hepatocellular carcinoma, cholangiocarcinoma, gallbladder cancer, colorectal liver metastases, lesions located in postero-superior liver segments, comparison between laparoscopic and robotic hepatic resections
The frequency of minor resections (69.6% vs. 74.3%, respectively), estimated blood loss (EBL) (293 mL vs. 292.5 mL, respectively), length of stay (LOS) (6.7 days vs. 6.2 days, respectively) and overall complications rates (16% vs. 15.7%, respectively) were similar between RS and laparoscopy, the conversion rate (5% vs. 9.25%, respectively) was lower for RS. These results suggest that RS could increase minimally invasive surgery (MIS) approach in complex cases requiring longer operative time
Summary
Robotic surgery (RS) has received great interest from scientific societies. In the era of minimally invasive surgery (MIS) it represents an advanced technique able to overcome some limitations of laparoscopy. The advantages of RS are several: it provides increased surgical dexterity and enhanced suturing ability, thanks to a magnified three-dimensional view of the operative field, hand tremor filtration and articulating instruments with seven-degrees of freedom. This approach reduces significantly surgeons’ fatigue, improving performances for long operations[1,2]. The Southampton international guidelines, providing indications and limits of liver MIS, advocated RS as a promising, but not yet standardized, approach[8]. The aim of this review was to analyze the results of robotic hepatobiliary surgery and to compare them with laparoscopy, in order to clarify the benefits and contraindications of RS
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