Robotic Liver Surgery – Current Standards and Future Perspectives

Abstract

Background Robotic liver surgery is emerging as the future of minimal invasive surgery. The robotic surgical system offers a stable camera platform, elimination of physiologic tremor, augmented surgical dexterity as well as improved ergonomics because of a seated operating position. Due to the theoretical advantages of the robotic assisted system, complex liver surgery might be an especially interesting indication for a robotic approach since it demands delicate tissue dissection, precise intracorporeal suturing as well as difficult parenchymal transection with subsequent need for meticulous hemostasis and biliostasis. Material and methods An analysis of English and German literature on open, laparoscopic and robotic liver surgery was performed and this review provides a general overview of the existing literature along with current standards and aims to specifically point out future directions of robotic liver surgery. Results Robotic liver surgery is safe and feasible compared to open and laparoscopic surgery, with improved short-term postoperative outcomes and at least non-inferior oncological outcomes. Conclusion In complex cases including major hepatectomies, extended hepatectomies with biliary reconstruction and difficult segmentectomies of the posterior-superior segments, robotic surgery appears to emerge as a reasonable alternative to open surgery rather than being an alternative to laparoscopic procedures.

Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients

“…Laparoscopic approach was considered difficult for these kind of lesions and also the anatomical landmarks are not clear as in anterior segments of the liver[ 8 , 19 ]. In complex cases including major hepatectomy, biliary reconstruction and difficult segmentectomy of the PSS, robotic surgery improved intra-operative and short-term postoperative outcomes[ 20 ].…”

Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery

“…As surgeons gain experience, the learning curve for robotic surgical approaches is likely to decrease[ 56 ]. In addition, as robotic surgery and open surgery share a common skill principle, even new surgeons with less experience may have a shorter learning curve on the operating table and a correspondingly shorter operating time[ 57 ].…”

“…Superimposed images: Reconstructed images can be displayed in a variety of ways, either video-based or projection-based. Video-based reconstructed image display is commonly used for laparoscopic, robotic and endoscopic procedures[ 57 ]. The external video monitor displays the actual surgical scene, and the virtual 3D reconstructed image in the video has poor resolution, requiring tracking and correction of multiple anatomical structures to compensate for changes in the surgeon's field of view and changes in the projected image due to changes in the curvature of the surface of the organ being tracked, this adds to the complexity of constructing the image[ 1 , 96 , 97 ].…”

The Role of ICG in Robot-Assisted Liver Resections

“…Presently, robotic procedures, including hepatic procedures, are being increasingly performed [ 1 , 2 , 3 ]. The advantages of robotic surgery are well known, and robotic liver surgery has been proven to be safe [ 4 , 5 , 6 ].…”

“…The advantages of robotic surgery are well known, and robotic liver surgery has been proven to be safe [ 4 , 5 , 6 ]. Despite advantages such as steady and clear 3D visualization, superior ergonomics, and improved dexterity, a major limitation of robotic surgery is its lack of haptic feedback, so much so that the surgeon purely relies on the visual aspects [ 1 , 7 , 8 ]. In open hepatic surgery, an intraoperative ultrasound (IOUS) is mandatory to add precision and allow real-time intraoperative, strategic imaging [ 9 ].…”