title: Robotic liver surgery is the optimal approach as bridge to transplantation.
abstract: The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas (HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of: (1) the small impact on abdominal wall; (2) the gentle manipulation on the liver; (3) the limited surgical trauma; and (4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.
authors.affiliation: Paolo Magistri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza - University of Rome, 00185 Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Magistri
authors.affiliation: Paolo Magistri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza - University of Rome, 00185 Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantino
authors.affiliation: Paolo Magistri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza - University of Rome, 00185 Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ballarin
authors.affiliation: Paolo Magistri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza - University of Rome, 00185 Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Coratti
authors.affiliation: Paolo Magistri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza - University of Rome, 00185 Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
keywords: Barcelona Clinic Liver Cancer; Bridge to transplantation; Da vinci; Hepatocellular carcinomas; Liver transplant; Patient safety; Robotic surgery