Abstract
The introduction of laparoscopic technology and surgical robots in hepatobiliary surgery in the 1990s and 2000s, respectively, has dramatically revolutionized the field. Even though laparoscopic and robotic major hepatectomy was slower to adopt compared to minimally-invasive minor hepatectomy, the number of major hepatectomies performed with both approaches worldwide has significantly increased and is still rising. Despite the few comparative studies between laparoscopic and robotic major hepatectomy, most studies are focused on describing the procedures or reporting the outcomes of each method, either separately, or mixed with minor hepatectomies. Based on the available data, the direct comparison between the two techniques has shown that when robotic major hepatectomy is performed by experienced hepatobiliary surgeons in high-volume centers, it can lead to similar operating times, estimated blood loss, hospital length of stay, complication and mortality rates compared to its laparoscopic counterpart. The likelihood of achieving a margin-negative resection in cancer patients, as well as long-term disease-free and overall-survival are comparable between the groups. However, broader adoption of the robotic approach might be a hurdle in low-volume centers due to the high fixed capital and annual maintenance cost of the surgical robot.
Highlights
The introduction of minimally-invasive technology in the approach of liver disorders in the early 1990s has since revolutionized the field of liver surgery[1,2,3,4,5]
When robotic major hepatectomy (RMH) and laparoscopic major hepatectomy (LMH) were performed for liver malignancies, none of the four studies showed a difference in surgical margin status between the two approaches, and long-term outcomes were comparable when reported[20,40,42,94]
The introduction of laparoscopy and robotic surgical systems in liver surgery has significantly changed the current state of practice
Summary
The introduction of minimally-invasive technology in the approach of liver disorders in the early 1990s has since revolutionized the field of liver surgery[1,2,3,4,5]. Laparoscopic liver surgery does include pure laparoscopy, and hand-assisted laparoscopic, as well as hybrid approaches, where the initial part of the procedure (i.e., liver mobilization, early dissection) is done laparoscopically, while later a small incision is made to complete the transection of the liver parenchyma[6,7]. The liver is classified in individual territories according to the segmentation of the vessels and bile ducts, introduced by Couinaud in the 1950s[8,9], and the Brisbane 2000 nomenclature is utilized to define minor and major hepatectomy in the field of liver surgery[10,11].
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