Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

Abstract

Hepatic surgery is a rapidly expanding component of abdominal surgery and is performed for a wide range of indications. The introduction of laparoscopic cholecystectomy in 1987 was a major change in abdominal surgery. Laparoscopic surgery was widely and rapidly adopted throughout the world for cholecystectomy initially and then applied to a variety of other procedures. Laparoscopic surgery became regularly applied to hepatic surgery, including segmental and major resections as well as organ donation. Many operations progressed from open surgery to laparoscopy to robot-assisted surgery, including colon resection, pancreatectomy, splenectomy thyroidectomy, adrenalectomy, prostatectomy, gastrectomy, and others. It is difficult to prove a data-based benefit using robot-assisted surgery, although laparoscopic and robot-assisted surgery of the liver are not inferior regarding major outcomes. When laparoscopic surgery initially became popular, many had concerns about its use to treat malignancies. Robot-assisted surgery is being used to treat a variety of benign and malignant conditions, and studies have shown no deterioration in outcomes. Robot-assisted surgery for the treatment of malignancies has become accepted and is now being used at more centers. The outcomes after robot-assisted surgery depend on its use at specialized centers, the surgeon’s personal experience backed up by extensive training and maintenance of international registries. Robot-assisted hepatic surgery has been shown to be associated with slightly less intraoperative blood loss and shorter hospital lengths of stay compared to open surgery. Oncologic outcomes have been maintained, and some studies show higher rates of R0 resections. Patients who need surgery for liver lesions should identify a surgeon they trust and should not be concerned with the specific operative approach used. The growth of robot-assisted surgery of the liver has occurred in a stepwise approach which is very different from the frenzy that was seen with the introduction of laparoscopic cholecystectomy. This approach allowed the identification of areas for improvement, many of which are at the nexus of engineering and medicine. Further improvements in robot-assisted surgery depend on the combined efforts of engineers and surgeons.

Robotic management of huge hepatic angiomyolipoma: A case report and literature review

“…However, our case report marks the documentation of robotic-assisted surgical resection of a right inferior lobe HAML, showcasing the innovative application of robotic surgical techniques in the treatment of this rare liver lesion. Using robot assistance in surgery represents an evolution of traditional minimally invasive surgical techniques [13]. That most laparoscopic procedures can be performed through robotic assistance underlines a transition from open surgery to laparoscopic surgery, and further, to robot-assisted surgery [14].…”

Application of laparoscopic surgery in gallbladder carcinoma

“…Due to the widespread application of laparoscopic liver resection, the International Laparoscopic Liver Society was formed in 2016 by a group of experts[ 31 ]. Single-incision and robot-assisted technology are also available for minimally invasive liver surgery[ 32 , 33 ]. Additionally, laparoscopic techniques have achieved great success in the treatment of adrenal, prostate, and rectal diseases, among others[ 34 - 36 ].…”

Comparison of the carotid corrected flow time and tidal volume challenge for assessing fluid responsiveness in robot-assisted laparoscopic surgery

“…Robot-assisted surgery is used extensively owing to its advantages of smaller surgical wounds, early recovery, clearer vision, and manipulation dexterity [2]. Venous return increases cardiac output through the modified head-down lithotomy positioning; however, further increases in intra-abdominal pressure decrease cardiac output.…”