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.

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Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10225265 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5265

Author(s):

Aristotelis Perrakis ◽

Mirhasan Rahimli ◽

Andrew A. Gumbs ◽

Victor Negrini ◽

Mihailo Andric ◽

...

Keyword(s):

Liver Surgery ◽

Liver Parenchyma ◽

R0 Resection ◽

Parenchymal Transection ◽

Minimally Invasive Liver Surgery ◽

Robotic Hepatectomy ◽

Liver Resections ◽

New Strategy ◽

Laparoscopic Techniques ◽

Robotic Liver Surgery

Background: The implementation of robotics in liver surgery offers several advantages compared to conventional open and laparoscopic techniques. One major advantage is the enhanced degree of freedom at the tip of the robotic tools compared to laparoscopic instruments. This enables excellent vessel control during inflow and outflow dissection of the liver. Parenchymal transection remains the most challenging part during robotic liver resection because currently available robotic instruments for parenchymal transection have several limitations and there is no standardized technique as of yet. We established a new strategy and share our experience. Methods: We present a novel technique for the transection of liver parenchyma during robotic surgery, using three devices (3D) simultaneously: monopolar scissors and bipolar Maryland forceps of the robot and laparoscopic-guided waterjet. We collected the perioperative data of twenty-eight patients who underwent this procedure for minor and major liver resections between February 2019 and December 2020 from the Magdeburg Registry of minimally invasive liver surgery (MD-MILS). Results: Twenty-eight patients underwent robotic-assisted 3D parenchyma dissection within the investigation period. Twelve cases of major and sixteen cases of minor hepatectomy for malignant and non-malignant cases were performed. Operative time for major liver resections (≥ 3 liver segments) was 381.7 (SD 80.6) min vs. 252.0 (70.4) min for minor resections (p < 0.01). Intraoperative measured blood loss was 495.8 (SD 508.8) ml for major and 256.3 (170.2) ml for minor liver resections (p = 0.090). The mean postoperative stay was 13.3 (SD 11.1) days for all cases. Liver surgery-related morbidity was 10.7%, no mortalities occurred. We achieved an R0 resection in all malignant cases. Conclusions: The 3D technique for parenchyma dissection in robotic liver surgery is a safe and feasible procedure. This novel method offers an advanced locally controlled preparation of intrahepatic vessels and bile ducts. The combination of precise extrahepatic vessel handling with the 3D technique of parenchyma dissection is a fundamental step forward to the standardization of robotic liver surgery for teaching purposing and the wider adoption of robotic hepatectomy into routine patient care.

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Augmented Reality and Image-Guided Robotic Liver Surgery

Cancers ◽

10.3390/cancers13246268 ◽

2021 ◽

Vol 13 (24) ◽

pp. 6268

Author(s):

Fabio Giannone ◽

Emanuele Felli ◽

Zineb Cherkaoui ◽

Pietro Mascagni ◽

Patrick Pessaux

Keyword(s):

Artificial Intelligence ◽

Augmented Reality ◽

Liver Surgery ◽

Tactile Feedback ◽

Parenchymal Transection ◽

Practical Applications ◽

Indocyanine Green Fluorescence ◽

Oncological Results ◽

Vascular Structures ◽

Robotic Liver Surgery

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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Pringle maneuver in robotic liver surgery: our experience

HPB ◽

10.1016/j.hpb.2018.06.2883 ◽

2018 ◽

Vol 20 ◽

pp. S461

Author(s):

B. Pesi ◽

M. Annecchiarico ◽

F. Tofani ◽

L. Bencini ◽

L. Moraldi ◽

...

Keyword(s):

Liver Surgery ◽

Pringle Maneuver ◽

Robotic Liver Surgery

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Robotic liver surgery: preliminary experience in a tertiary hepato-biliary unit

Updates in Surgery ◽

10.1007/s13304-015-0285-4 ◽

2015 ◽

Vol 67 (1) ◽

pp. 27-32 ◽

Cited By ~ 16

Author(s):

Emanuele Felli ◽

Roberto Santoro ◽

Marco Colasanti ◽

Giovanni Vennarecci ◽

Pasquale Lepiane ◽

...

Keyword(s):

Liver Surgery ◽

Robotic Liver Surgery

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Mantle cell lymphoma – Current standards of care and future directions

Cancer Treatment Reviews ◽

10.1016/j.ctrv.2017.05.008 ◽

2017 ◽

Vol 58 ◽

pp. 51-60 ◽

Cited By ~ 8

Author(s):

Peter Martin ◽

Paola Ghione ◽

Martin Dreyling

Keyword(s):

Mantle Cell Lymphoma ◽

Cell Lymphoma ◽

Standards Of Care ◽

Future Directions ◽

Mantle Cell ◽

Current Standards

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Historical evolution and current state of robotic liver surgery

Laparoscopic Surgery ◽

10.21037/ls.2019.05.04 ◽

2019 ◽

Vol 3 ◽

pp. 21-21

Author(s):

Iswanto Sucandy ◽

Andres Giovannetti

Keyword(s):

Liver Surgery ◽

Historical Evolution ◽

Current State ◽

Robotic Liver Surgery

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Establishment and Application of Prostate Cancer Circulating Tumor Cells in the Era of Precision Medicine

BioMed Research International ◽

10.1155/2017/7206307 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Yoon Seok Suh ◽

Jae Young Joung ◽

Sung Han Kim ◽

Ho Kyung Seo ◽

Jinsoo Chung ◽

...

Keyword(s):

Prostate Cancer ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Liquid Biopsy ◽

Disease Status ◽

Minimal Invasive ◽

Future Directions ◽

Advantages And Disadvantages ◽

Potential Tool ◽

Selection Of

Prostate cancer (PC) is the second most common cancer in men and is the fifth leading cause of cancer-related deaths worldwide. Additionally, there is concern for overdiagnosis and overtreatment of PC. Thus, selection of an appropriate candidate for active surveillance as well as more accurate and less invasive tools for monitoring advanced PC is required. Circulating tumor cells (CTCs) have emerged as a liquid biopsy tool; there have been several reports on its role, technologies, and applications to various cancers, including PC. Liquid biopsy using CTCs has been gaining attention as a minimal invasive tool for investigation of biomarkers and for prognosis and assessment of response to therapies in patients with PC. Because of the lower invasiveness of liquid biopsy using CTCs, it can be performed more frequently; accordingly, personalized disease status can be successively determined at serial time points. CTC analysis enables detection of genomic alterations, which is drug-targetable, and it is a potential tool for monitoring response to therapeutic agents in patients with PC. This review focuses on the characteristics, technologies for analysis, and advantages and disadvantages of CTCs as a liquid biopsy tool and their application in PC. Finally, we propose future directions of CTCs.

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