Pan-European survey on the implementation of robotic and laparoscopic minimally invasive liver surgery

Zwart, M.; Görgec, Burak; Arabiyat, Abdullah; Nota, C.; Poel, Marcel J. van der; Fichtinger, R.; Berrevoet, Frederik; Dam, Ronald M. van; Aldrighetti, Luca; Fuks, David; Hoti, Emir; Edwin, Bjørn; Besselink, Marc G.; Hilal, Mohammed Abu; Hagendoorn, Jeroen; Swijnenburg, Rutger-Jan

doi:10.1016/j.hpb.2021.08.939

Cited by 33 publications

(30 citation statements)

References 42 publications

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“…Conversion rate to open decreased by 4.5% after 70 operations [ 61 ]. Zwart et al found a reduction in operative time and conversion to open after 55 operations and a second reduction point after 145 cases for conversion rate [ 62 ].…”

Section: Learning Curvementioning

confidence: 99%

See 1 more Smart Citation

Robotic-Assisted Surgery for Primary Hepatobiliary Tumors—Possibilities and Limitations

Spiegelberg

Iken

Fichtner‐Feigl

2022

Cancers

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Hepatocellular and cholangiocellular carcinoma are fatal primary hepatic tumors demanding extensive liver resection. Liver surgery is technically challenging due to the complex liver anatomy, with an intensive and variant vascular and biliary system. Therefore, major hepatectomies in particular are often performed by open resection and minor hepatectomies are often performed minimally invasively. More centers have adopted robotic-assisted surgery, intending to improve the laparoscopic surgical limits, as it offers some technical benefits such as seven degrees of freedom and 3D visualization. The da Vinci® Surgical System has dominated the surgical robot market since 2000 and has shown surgical feasibility, but there is still much controversy about its economic benefits and real benefits for the patient over the gold standard. The currently available retrospective case studies are difficult to compare, and larger, prospective studies and randomized trials are still urgently missing. Therefore, here we summarize the technical, surgical, and economic outcomes of robotic versus open and laparoscopic hepatectomies for primary liver tumors found in the latest literature reviews and meta-analyses. We conclude that complex robotic liver resections (RLR) are safe and feasible after the steep learning curve of the surgical team has plateaued. The financial burden is lower in high volume centers and is expected to decrease soon as new surgical systems will enter the market.

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Section: Learning Curvementioning

confidence: 99%

“…Zwart et al showed, that the vessel sealer is the second most used device for parenchymal transection in an Pan-European survey including 120 surgeons in 24 countries [ 62 ].…”

Section: Technical and Surgical Aspectsmentioning

confidence: 99%

Robotic-Assisted Surgery for Primary Hepatobiliary Tumors—Possibilities and Limitations

Spiegelberg

Iken

Fichtner‐Feigl

2022

Cancers

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“…According to the updated Southampton guidelines, hepatic surgery should preferably be performed with a minimally invasive approach [ 1 , 25 , 26 , 27 , 28 , 29 ]. In this context, RALS was first reported by Giulianotti et al in 2003 and is gaining more and more popularity [ 17 , 26 , 27 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of ICG in Robot-Assisted Liver Resections

Mehdorn

Richter

Heß

et al. 2022

JCM

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Introduction: Robotic-assisted liver surgery (RALS) with its known limitations is gaining more importance. The fluorescent dye, indocyanine green (ICG), is a way to overcome some of these limitations. It accumulates in or around hepatic masses. The integrated near-infrared cameras help to visualize this accumulation. We aimed to compare the influence of ICG staining on the surgical and oncological outcomes in patients undergoing RALS. Material and Methods: Patients who underwent RALS between 2014 and 2021 at the Department of General Surgery at the University Hospital Schleswig-Holstein, Campus Kiel, were included. In 2019, ICG-supported RALS was introduced. Results: Fifty-four patients were included, with twenty-eight patients (50.9%) receiving preoperative ICG. Hepatocellular carcinoma (32.1%) was the main entity resected, followed by the metastasis of colorectal cancers (17%) and focal nodular hyperplasia (15.1%). ICG staining worked for different tumor entities, but diffuse staining was noted in patients with liver cirrhosis. However, ICG-supported RALS lasted shorter (142.7 ± 61.8 min vs. 246.4 ± 98.6 min, p < 0.001), tumors resected in the ICG cohort were significantly smaller (27.1 ± 25.0 mm vs. 47.6 ± 35.2 mm, p = 0.021) and more R0 resections were achieved by ICG-supported RALS (96.3% vs. 80.8%, p = 0.075). Conclusions: ICG-supported RALS achieve surgically and oncologically safe results, while overcoming the limitations of RALS.

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“…Throughout the last two decades, several papers have confirmed the feasibility of minimally invasive liver surgery (MILS) and shown the advantages of MILS over open liver resection, especially regarding hospital stay and postoperative morbidity (1)(2)(3)(4). However, the widespread use of MILS is not the reality yet, ranging from 10% in some countries (5) to up to 30% in others, depending on expertise, availability, and surgical volume (6).…”

Section: Laparoscopic and Robotic Liver Surgerymentioning

confidence: 99%

“…However, the widespread use of MILS is not the reality yet, ranging from 10% in some countries ( 5 ) to up to 30% in others, depending on expertise, availability, and surgical volume ( 6 ). A recent survey has shown that, even in highly specialized European centers, MILS comprised about one third of all liver resections ( 2 ). These numbers are expected to increase further in the near future, once MILS have been incorporated as part of the general training program, especially in the HPB fellowship program.…”

mentioning

confidence: 99%