Shimizu Atsushi, Ito Miwa, Lefor Alan Kawarai
Department of Surgery, Jichi Medical University, Shimotsuke 329-0498, Tochigi, Japan.
J Clin Med. 2022 Jun 7;11(12):3254. doi: 10.3390/jcm11123254.
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.
肝脏手术是腹部手术中迅速发展的一个组成部分，其施行的适应证范围广泛。1987年腹腔镜胆囊切除术的引入是腹部手术的一项重大变革。腹腔镜手术最初在全世界被广泛且迅速地应用于胆囊切除术，随后又应用于各种其他手术。腹腔镜手术逐渐常规应用于肝脏手术，包括肝段和大的肝切除术以及活体肝移植。许多手术从开放手术发展到腹腔镜手术，再到机器人辅助手术，包括结肠切除术、胰腺切除术、脾切除术、甲状腺切除术、肾上腺切除术、前列腺切除术、胃切除术等等。尽管肝脏的腹腔镜手术和机器人辅助手术在主要结局方面并不逊色，但很难用数据证明机器人辅助手术的益处。当腹腔镜手术最初流行时，许多人对其用于治疗恶性肿瘤存在担忧。机器人辅助手术正被用于治疗各种良性和恶性疾病，并且研究表明其结局并未恶化。机器人辅助手术治疗恶性肿瘤已被接受，现在有更多的中心在使用。机器人辅助手术后的结局取决于其在专业中心的使用情况、外科医生通过广泛培训积累的个人经验以及国际登记系统的维护。与开放手术相比，机器人辅助肝脏手术已被证明术中失血量略少且住院时间更短。肿瘤学结局得到了维持，一些研究显示R0切除率更高。需要进行肝脏病变手术的患者应找到他们信任的外科医生，而不应担心所采用的具体手术方式。肝脏机器人辅助手术的发展是逐步进行的，这与腹腔镜胆囊切除术引入时的狂热情况大不相同。这种方式使得能够确定改进的领域，其中许多领域处于工程学和医学的交叉点。机器人辅助手术的进一步改进依赖于工程师和外科医生的共同努力。
