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Minerva Surgery 2022 August;77(4):380-90

DOI: 10.23736/S2724-5691.22.09629-0

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

The current and future role of robotic surgery in liver surgery and transplantation

Michele FINOTTI 1, 2 , Francesco D’AMICO 3, 4, Giuliano TESTA 1

1 Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA; 2 Fourth Surgery Unit, Regional Hospital Treviso, DISCOG, University of Padua, Padua, Italy; 3 Unit of Transplantation and Hepatobiliary Surgery, University of Padua, Padua, Italy; 4 Department of Surgery, Yale University School of Medicine, New Haven, CT, USA



Minimally invasive surgery (MIS) is gaining interest in all surgical fields, especially in the hepatobiliary and liver transplant branch with excellent outcomes. However, its application especially in the living donation, is at the beginning and still controversial, with few published studies. A literature review was performed using the following keywords reviewing the current role of robotic donor hepatectomy in the literature and to evaluate the possible future implication in the transplant field: minimally invasive liver surgery, laparoscopic liver surgery, robotic liver surgery, robotic living donation, laparoscopic donor hepatectomy, robotic donor hepatectomy. 3-D imaging with high definition and stable view, a more rapid learning curve than the laparoscopic one and the lack of hand tremors and the freedom of movements are all important advantages claimed in favor of robotic surgery. Furthermore, most of the studies showed, compared to open surgery, less postoperative pain, less intraoperative blood loss, and a shorter period before returning to normal activity to the detriment of longer operation time. The excellent outcome can be explained thanks to the three-dimensional and magnification view that allows for better evaluation compared to the laparoscopic approach to the right plane of transection, vascular and biliary anatomy, and thanks to the precision of the movements a better bleeding control. Robotic approach, especially in living donor hepatectomy, is considered safe and feasible, even if its superiority compared to the open and laparoscopic approaches needs further evaluation.


KEY WORDS: Liver; Minimally invasive surgical procedures; Tissue donors; Laparoscopy; Hepatectomy; Robotics

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