Palucci Marco, Giannone Fabio, Del Angel-Millán Gabriela, Alagia Mariantonietta, Del Basso Celeste, Lodin Marco, Monsellato Igor, Sangiuolo Federico, Cassese Gianluca, Panaro Fabrizio
Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
University of Eastern Piedmont Amadeo Avogadro, Vercelli, Italy.
J Robot Surg. 2024 Dec 30;19(1):36. doi: 10.1007/s11701-024-02200-5.
Robotic liver surgery is experiencing a period of great development, but some hurdles still need to be overcome. Parenchymal transection remains one of the most technically challenging steps. The lack of dedicated instruments and the flourishing of several techniques didn't allow surgeons to reach a standard technique so far. The aim of the present paper is to provide an overview of the different robotic liver transection techniques described to date, highlighting the strengths and weaknesses of each one. We conducted an extensive search on PubMed, Scopus and Web of Science, inserting the following keywords: "robotic liver transection, robotic hepatic transection" and focusing particularly on technical reports and paper regarding new surgical methods. This search resulted in a total of 13 different surgical techniques. All the methods described can be classified into two categories the "hybrid techniques" and the "fully robotic techniques" which are based, respectively, on the combined use of laparoscopic and robotic instrumentation or exclusively robotic devices. Another fundamental difference is the division between "one-surgeon" and "two-surgeon techniques", which depends on the level of expertise required of the assistant surgeon at the operating table. This is the first comprehensive review on this topic. Although the existing literature does not allow one technique to be established as superior to the others, the adoption of a standardized method of robotic hepatic transection is highly desirable to optimize surgical results and to allow better comparability of outcomes within the scientific community.
机器人肝脏手术正处于快速发展阶段，但仍有一些障碍需要克服。肝实质离断仍然是最具技术挑战性的步骤之一。专用器械的缺乏以及多种技术的蓬勃发展，使得外科医生至今仍未能达成一种标准技术。本文旨在概述迄今为止所描述的不同机器人肝脏离断技术，突出每种技术的优缺点。我们在PubMed、Scopus和科学网进行了广泛检索，插入了以下关键词：“机器人肝脏离断、机器人肝离断”，并特别关注有关新手术方法的技术报告和论文。此次检索共得到13种不同的手术技术。所描述的所有方法可分为两类——“混合技术”和“完全机器人技术”，它们分别基于腹腔镜和机器人器械的联合使用或仅使用机器人设备。另一个根本区别是“单主刀”和“双主刀技术”之间的划分，这取决于手术台上助手所需的专业水平。这是关于该主题的首次全面综述。尽管现有文献无法确定一种技术优于其他技术，但采用标准化的机器人肝离断方法对于优化手术效果以及在科学界实现更好的结果可比性非常必要。
