Bozkurt Emre, Sijberden Jasper P, Hilal Mohammed Abu
Department of Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy.
Department of Surgery, Hepatopancreatobiliary Surgery Division, Koç University Hospital, Istanbul 34010, Turkey.
Cancers (Basel). 2022 Aug 31;14(17):4268. doi: 10.3390/cancers14174268.
In parallel with the historical development of minimally invasive surgery, the laparoscopic and robotic approaches are now frequently utilized to perform major abdominal surgical procedures. Nevertheless, the role of the robotic approach in liver surgery is still controversial, and a standardized, safe technique has not been defined yet. This review aims to summarize the currently available evidence and prospects of robotic liver surgery. Minimally invasive liver surgery has been extensively associated with benefits, in terms of less blood loss, and lower complication rates, including liver-specific complications such as clinically relevant bile leakage and post hepatectomy liver failure, when compared to open liver surgery. Furthermore, comparable R0 resection rates to open liver surgery have been reported, thus, demonstrating the safety and oncological efficiency of the minimally invasive approach. However, whether robotic liver surgery has merits over laparoscopic liver surgery is still a matter of debate. In the current literature, robotic liver surgery has mainly been associated with non-inferior outcomes compared to laparoscopy, although it is suggested that the robotic approach has a shorter learning curve, lower conversion rates, and less intraoperative blood loss. Robotic surgical systems offer a more realistic image with integrated 3D systems. In addition, the improved dexterity offered by robotic surgical systems can lead to improved intra and postoperative outcomes. In the future, integrated and improved haptic feedback mechanisms, artificial intelligence, and the introduction of more liver-specific dissectors will likely be implemented, further enhancing the robots' abilities.
随着微创手术的历史发展，腹腔镜和机器人手术方法如今经常被用于实施大型腹部外科手术。然而，机器人手术方法在肝脏手术中的作用仍存在争议，尚未确定标准化的安全技术。本综述旨在总结机器人肝脏手术的现有证据和前景。与开放肝脏手术相比，微创肝脏手术在减少失血和降低并发症发生率方面具有诸多益处，包括肝脏特异性并发症，如具有临床意义的胆漏和肝切除术后肝衰竭。此外，已有报道称微创肝脏手术的R0切除率与开放肝脏手术相当，从而证明了微创方法的安全性和肿瘤学疗效。然而，机器人肝脏手术是否优于腹腔镜肝脏手术仍是一个有争议的问题。在当前文献中，与腹腔镜手术相比，机器人肝脏手术的主要相关结果并不逊色，尽管有人认为机器人手术方法的学习曲线更短、转换率更低且术中失血量更少。机器人手术系统通过集成3D系统提供更逼真的图像。此外，机器人手术系统提供的更高灵活性可带来更好的术中和术后结果。未来，可能会实施集成和改进的触觉反馈机制、人工智能，并引入更多肝脏特异性解剖器械，进一步提升机器人的能力。
