Surgical and oncological outcomes after ultrasound‐guided robotic liver resections for malignant tumor. Analysis of a prospective database

Pesi, Benedetta; Moraldi, Luca; Guerra, Francesco; Tofani, Federica; Nerini, Alessandro; Annecchiarico, Mario; Coratti, Andrea

doi:10.1002/rcs.2002

Cited by 8 publications

(4 citation statements)

References 39 publications

(132 reference statements)

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“…Pesi et al, 2019 analysed surgical and oncological outcomes of a series of 51 patients who received ultrasound-guided robotic liver resections (RLRs) for both primary and secondary malignancies. Their results showed that robotic liver surgery is effective with acceptable uncompromised long-term oncological outcomes [17]. Fruscione et al, 2019 compared robotic-assisted (57 cases) versus laparoscopic (116 cases) major liver resections from a single centre.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review Comparing the Effectiveness of Robotic verse Laparoscopic Liver Surgery in Colorectal Liver Metastasis (CRLM)

et al. 2021

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Introduction: Colorectal cancer (CRC) is the third most common cancer in the world. The liver is the most common site of metastasis with 15 to 25% of patients presenting with synchronous colorectal liver metastasis (CRLM). This study is aimed at evaluating the long- and short-term outcomes of laparoscopic and robotic CRLM surgery, and directly comparing their respective effectiveness. Methodology: A literature search was performed and all studies that reported on operative characteristics, oncological outcomes for CRLM, morbidity or mortality and cost-effectiveness on robotic or laparoscopic surgery were included. The study design was in keeping with the PRISMA guidelines. Results: From the initial 606 manuscripts identified, 19 studies were included in the final qualitative analysis. A total of 1340 patients with 1194 LLR (Laparoscopic Liver Resection) and 146 RLR (Robotic Liver Resection) cases were analysed. Within the LLR group, the average tumour size excised was 32.1 mm compared to the RLR group of 33.8 mm. The average operative time in the LLR was 193 min, CI of 95% (147.4 min to 238.6 min) compared to RLR 257 min, CI of 95% (201.5 min to 313.8 min) with a p-value < 0.0001. Estimated blood loss was lower in the RLR group (210 mL) compared with the LLR group (246 mL). Conclusion: Despite the higher operative cost, RLRs do not result in statistically better treatment outcomes, with the exception of lower estimated blood loss and excision of larger CRLMs. Operative time and total complication rate are significantly more favourable with LLRs. Our study has shown that robotic liver surgery is safe and feasible in well-selected patients.

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Section: Discussionmentioning

confidence: 99%

Systematic Review Comparing the Effectiveness of Robotic verse Laparoscopic Liver Surgery in Colorectal Liver Metastasis (CRLM)

et al. 2021

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“…published, and results seem promising in terms of surgical and oncological outcomes [48,49]. Other interesting solutions in the field of the US-guider robotic liver surgery have been described in preclinical trials [50][51][52].…”

Section: Intra-operative Robotic Ultrasound Applicationmentioning

confidence: 99%

“…Moreover, thanks to software such as TilePro, the operator can shift from the 3D camera view to the ultrasound directly from the console, or even create a split-view with both intraoperative and ultrasound images ( Figure 4 ). Despite all the drawbacks related to the costs and a newborn technology, a few series regarding US-guided robotic liver resection have been published, and results seem promising in terms of surgical and oncological outcomes [ 48 , 49 ].…”

Section: Image-guided Robotic Liver Surgerymentioning

confidence: 99%

Augmented Reality and Image-Guided Robotic Liver Surgery

Giannone

Felli

Cherkaoui

et al. 2021

Cancers

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Artificial intelligence makes surgical resection easier and safer, and, at the same time, can improve oncological results. The robotic system fits perfectly with these more or less diffused technologies, and it seems that this benefit is mutual. In liver surgery, robotic systems help surgeons to localize tumors and improve surgical results with well-defined preoperative planning or increased intraoperative detection. Furthermore, they can balance the absence of tactile feedback and help recognize intrahepatic biliary or vascular structures during parenchymal transection. Some of these systems are well known and are already widely diffused in open and laparoscopic hepatectomies, such as indocyanine green fluorescence or ultrasound-guided resections, whereas other tools, such as Augmented Reality, are far from being standardized because of the high complexity and elevated costs. In this paper, we review all the experiences in the literature on the use of artificial intelligence systems in robotic liver resections, describing all their practical applications and their weaknesses.

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“…In addition, RS supports and upgrades the technology of specific surgical tools, that can help surgeons to face challenging situations and improve surgical results, such as with intraoperative ultrasound, near-infrared fluorescence with indocyanine green, CT and MR images integrated into the robotic console. The images can be simultaneously displayed with the operative field during liver parenchymal transection, allowing the surgeon to change the previously marked transection line if necessary and to detect further lesions, gaining adequate margins for malignancies [3][4][5] . On the contrary, current RS systems' disadvantages include the absence of a dedicated instrument for transection (i.e., CUSA), the need for additional surgeons and time for instrument replacement, the learning curve of the team to dock the instruments and the lack of haptic feedback [2] .…”

Section: Introductionmentioning

confidence: 99%

Robotic liver surgery: literature review and current evidence

Ruzzenente¹,

Alaimo²,

Conci³

et al. 2020

Mini-invasive Surg

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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.

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Surgical and oncological outcomes after ultrasound‐guided robotic liver resections for malignant tumor. Analysis of a prospective database

Cited by 8 publications

References 39 publications

Systematic Review Comparing the Effectiveness of Robotic verse Laparoscopic Liver Surgery in Colorectal Liver Metastasis (CRLM)

Systematic Review Comparing the Effectiveness of Robotic verse Laparoscopic Liver Surgery in Colorectal Liver Metastasis (CRLM)

Augmented Reality and Image-Guided Robotic Liver Surgery

Robotic liver surgery: literature review and current evidence

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