Robotic hepatectomies: advances and perspectives.
BACKGROUND
Over recent years, minimally invasive hepatic resections have increasingly been reported in the literature. Even though hepatic surgery is still considered a challenge for surgeons due to its technical difficulties and high morbidity, the development and spread of robotic surgery has highlighted a new interest, which has induced a rapid dissemination of robotic approaches for hepatic pathologies. This article presents a systematic review of the literature regarding robotic hepatectomy in order to assess the safety and feasibility of robotic hepatic surgery.


METHODS
All eligible studies in robotic liver surgery which were published between January 2001 and January 2016 were reviewed systematically. Only series of ten patients and more were chosen in order to consider the experience of high-volume centers. In case of multiple articles on the same centers, the study including the largest number of patients was considered for the study. Overall, 18 studies, involving a total of 572 robotic liver resection (RLR) were finally analyzed.


RESULTS
All articles in this review demonstrate that robotic liver surgery must be performed by surgeons trained in open liver surgery and skilled in minimally invasive techniques.


CONCLUSIONS
RLR and laparoscopic liver resection (LLR) were comparable in terms of safety, feasibility, and outcome for hepatectomies. However, RLR is more expensive than LLR. Further studies are required before any final conclusion can be drawn.
Hepato-Biliary and Pancreatic Surgical Unit, General, Digestive, and Endocrine Surgery, IRCAD, IHU Mix-Surg, Institute for Minimally Invasive Image-Guided Surgery, University of Strasbourg, Strasbourg, France - drmemeo@yahoo.it.
Ammar
A
Dehlawi
Riccardo
R
Memeo
Vito
V
DE Blasi
Henry A
HA
Mercoli
Didier
D
Mutter
Jacques
J
Marescaux
Patrick
P
Pessaux
D000075202:Contraindications; D003362:Cost-Benefit Analysis; D006498:Hepatectomy / Q000191:economics / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008107:Liver Diseases / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods; D012371:Robotics / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome