Robotic Assisted Surgery A

**11**

**Chapter 2**

**Abstract**

future perspectives.

**1. Introduction**

anastomosis [2].

Robotic Liver Surgery

*Mushfique Alam, Robert Young and Rafael Diaz-Nieto*

**Keywords:** robotic surgery, robotic liver resection, hepatectomy,

minimally invasive surgery, laparoscopic liver surgery

trials (RCTs) recently published in the literature [3].

requirements attached to this type of resections.

Minimally invasive surgery has experienced a significant expansion in the last decades. Robotic surgery has evolved in parallel to traditional laparoscopic surgery offering additional technical advantages. Some specific aspect of

Hepatobiliary Surgery led to a limited implementation of minimally invasive liver surgery in the early years of laparoscopic surgery whilst we are experiencing an exponential increase in the use of minimally invasive approaches to this type of intervention. In this chapter we describe the key aspect of robotic liver surgery with a meticulous description of the supporting evidence, its limitation and

Hepatic resection is the gold standard treatment for some of the most common malignant tumours of the liver, including primary tumours (hepatocellular carcinoma and cholangiocarcinoma) and colorectal liver metastasis and it can be sometimes the treatment option for some benign tumours [1]. Hepatobiliary surgery also includes complex biliary interventions for benign and malignant pathologies that, in addition to the liver resection, may require biliary reconstructions and bilioenteric

Open surgery remains the predominant approach for most of these hepatobiliary procedures. However, there is an exponential increase of minimally invasive surgery (MIS) within this field, supported by large cases series and randomised control

Outcomes from the available literature suggests that MIS for liver resections improves patients' outcomes in terms of length of stay, blood loss and postoperative complications. Although some series suggest longer operative time and higher initial costs, the overall cost-efficiency seems to favour laparoscopic surgery [4, 5]. Despite this data, laparoscopic liver surgery is not routinely performed in all Hepatobiliary Centres and there is a large proportion of patients being treated via open approach. The delayed implementation of this type of intervention is commonly related to the technical challenges of these operations, the long tradition of open surgery associated to liver transplantation and the specific technological

From the original era of the pioneers in laparoscopic surgery, the consensus meetings in Louisville and Morikawa highlighted the challenges of this new approach. Recommendations from these meetings were very cautious about suggesting laparoscopic liver surgery for every patient and limited its clear indication to
