Soyama Akihiko, Hamada Takashi, Adachi Tomohiko, Eguchi Susumu
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Hepatol Res. 2024 Sep;54(9):786-794. doi: 10.1111/hepr.14058. Epub 2024 May 27.
Robotic liver resection has been reported in case series since the early 2000s. The surgical robot is capable of precise operation using articulated forceps with seven degrees of freedom. The robot also eliminates tremors and provides a good surgical field with highly detailed 3D high-definition images. The clinical results demonstrating their usefulness have been increasing year by year. Initially, a shorter hospital stay was observed in comparison with open hepatectomy. Recent reports have also shown lower conversion and complication rates in comparison with laparoscopic hepatectomy. The clamp and crush method with bipolar forceps, sealing devices, ultrasonic shears, and the combined procedure of Cavitron ultrasonic surgical aspirator and robotic forceps as hybrid procedures have been reported as effective methods of parenchymal transection in robotic surgery. Theoretically, the advantages of the robotic platform allow for more complex liver resection around hilar structures and major blood vessels, as well as for vascular reconstruction or biliary reconstruction. The application of robotic liver surgery for hilar cholangiocarcinoma, living donor hepatectomy, and living donor liver transplantation has been reported. Robotic liver surgery is becoming more popular for certain indications; however, it is important to further evaluate its long-term surgical and oncological outcomes and costs in comparison with conventional laparoscopic and open liver surgery, based on accumulated experience.
自21世纪初以来，病例系列报道了机器人肝脏切除术。手术机器人能够使用具有七个自由度的关节钳进行精确操作。该机器人还能消除震颤，并通过高度详细的3D高清图像提供良好的手术视野。证明其有用性的临床结果逐年增加。最初，与开放性肝切除术相比，观察到住院时间更短。最近的报告还显示，与腹腔镜肝切除术相比，中转率和并发症发生率更低。使用双极钳、密封装置、超声刀的钳夹压榨法，以及超声外科吸引器与机器人钳的联合操作作为混合手术，已被报道为机器人手术中实质离断的有效方法。从理论上讲，机器人平台的优势使得在肝门结构和主要血管周围进行更复杂的肝脏切除，以及进行血管重建或胆道重建成为可能。机器人肝脏手术在肝门部胆管癌、活体供肝肝切除术和活体肝移植中的应用已有报道。机器人肝脏手术在某些适应证方面越来越受欢迎；然而，基于积累的经验，与传统腹腔镜和开放性肝脏手术相比，进一步评估其长期手术、肿瘤学结局和成本非常重要。
