Pilz da Cunha Gabriela, Lips Daan J, Ahmad Jawad, Kvarnström Niclas, Aldrighetti Luca, D'Hondt Mathieu, Hagendoorn Jeroen, Swijnenburg Rutger-Jan
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
Hepatobiliary Surg Nutr. 2024 Dec 1;13(6):991-1006. doi: 10.21037/hbsn-23-510. Epub 2024 Jul 11.
The robotic platform enables surgeons to operate with a similar level of freedom and control as in open surgery, while still providing the patient with the benefits of a minimally invasive approach. More centres continue to adopt robotic liver surgery however standardized training materials and consensus on the surgical technique are currently lacking. The availability of a standardized surgical protocol could benefit the further dissemination of the robotic approach while promoting safe and effective operating techniques. We present a comprehensive surgical technique description for robotic hepatectomy agreed upon by seven expert robotic liver surgeons in Europe. They contributed insights from their extensive experience with the robot to develop this report, highlighting the key steps and important considerations for performing robotic hepatectomy. We describe the surgical technique for four most common hepatectomy types with varying complexity: partial anterolateral resections, partial posterosuperior resections, left hepatectomy and right hepatectomy. This report encompasses recommendations from the experts, covering the preparatory steps such as patient selection and pre-operative imaging, and extending through to care in the postoperative phase. The step-by-step surgical technique description serves as a compendium of best practice methods presently utilized in robotic liver surgery. Although some variations in technique cannot be eliminated from practice, general recommendations in a structured form will help to homogenize the technique, safeguarding surgical quality. This paper aims to inform and advise surgeons in the process of adopting robotic liver surgery and can act as a starting point for further optimization and refinement of the technique.
机器人平台使外科医生能够以与开放手术相似的自由度和控制水平进行操作，同时仍能为患者提供微创方法的益处。越来越多的中心继续采用机器人肝脏手术，然而目前缺乏标准化的培训材料和关于手术技术的共识。标准化手术方案的可用性有助于机器人手术方法的进一步推广，同时促进安全有效的手术技术。我们介绍了一份由欧洲七位机器人肝脏手术专家商定的机器人肝切除术综合手术技术描述。他们贡献了丰富的机器人手术经验，以编写本报告，突出了机器人肝切除术的关键步骤和重要注意事项。我们描述了四种不同复杂程度的最常见肝切除术类型的手术技术：部分前外侧切除术、部分后上切除术、左肝切除术和右肝切除术。本报告涵盖了专家的建议，包括患者选择和术前影像学检查等准备步骤，一直延伸到术后护理。逐步的手术技术描述是目前机器人肝脏手术中最佳实践方法的汇编。虽然实践中无法消除技术上的一些差异，但结构化形式的一般建议将有助于使技术同质化，保障手术质量。本文旨在为采用机器人肝脏手术的外科医生提供信息和建议，并可作为该技术进一步优化和完善的起点。
