In a recent review article published in the journal Laparoscopic, Endoscopic and Robotic Surgery, researchers explored the current state and future potential of robotic surgery for liver transplantation. They reviewed existing literature on robotic liver resection in living donors, robotic hepatectomy, and graft implantation in liver recipients, noting both benefits and limitations. They also addressed technical challenges and potential solutions to enhance robotic surgery in this field.
Study: Robotic surgery in living liver donors and liver recipients. Image Credit: Gorodenkoff/Shutterstock.com
Background
Robotic surgery is a minimally invasive technique that employs advanced robotic systems to perform complex procedures with high precision and reduced risk. It is increasingly used in liver transplantation, benefiting both donors and recipients. Liver transplantation is a vital treatment for end-stage liver disease or liver cancer.
Due to the shortage of deceased donor organs and the high mortality rate on the waiting list, living donor liver transplantation (LDLT) has emerged. LDLT involves a healthy person donating part of their liver, requiring a complex procedure to remove a liver segment from the donor and implant it into the recipient. Traditionally, this is performed through open surgery, which involves a large incision and lengthy recovery. Minimally invasive methods, such as laparoscopy and robotics, have been introduced to reduce surgical trauma and improve outcomes.
Laparoscopy uses a camera and instruments inserted through small abdominal incisions, while robotics involves a computer-controlled system mimicking the surgeon’s hand movements. Both techniques offer improved visualization, reduced blood loss, less pain, faster recovery, and better cosmetic results. Robotics additionally provides enhanced dexterity, stability, and ergonomics, facilitating challenging tasks like parenchymal transection, vascular anastomosis, and biliary reconstruction.
About the Study
In this review, the authors aimed to summarize the current literature and experience with robotic surgery in liver transplantation for both living donors and recipients. They conducted a comprehensive search on PubMed, Scopus, and Web of Science for articles published from 2012 to 2024, using keywords such as "liver transplantation," "robotic surgery," "robotic liver resection," "robotic hepatectomy," and "robotic liver implantation."
They included studies that discussed the feasibility, safety, outcomes, limitations, learning curve, and future perspectives of robotic surgery in liver transplantation. Studies lacking detailed information on the surgical technique, outcomes, complications, or those involving hybrid or hand-assisted approaches were excluded.
Using these criteria, the researchers identified 16 articles covering 1,027 robotic liver resections in living donors and 7 robotic liver implantations in recipients. They analyzed data on surgical techniques, operation times, blood loss, conversion rates, complications, hospital stays, and graft function. Additionally, they discussed technical challenges, the learning curve, and cost-effectiveness.
The review aimed to provide a comprehensive overview of the current state of robotic surgery in liver transplantation, highlighting its benefits and challenges and offering insights into its future development and potential for broader adoption in clinical practice.
Research Findings
The outcomes indicated that robotic surgery for living donors was feasible and safe, with results comparable to or better than open or laparoscopic surgery. It was primarily used for right hepatectomy, the most demanding procedure, but also for left hepatectomy and left lateral sectionectomy. The benefits included reduced blood loss, postoperative pain, and hospital stay while maintaining graft quality and function. The main drawbacks were longer operation times and higher costs, though these might decrease with experience and technological advances.
The authors found that robotic surgery in recipients was feasible and promising but still developing, with only a few cases reported. It was used for both hepatectomy and graft implantation, either as a pure or hybrid technique. Robotic surgery improved the accuracy and ease of vascular and biliary anastomoses, which is crucial for graft survival. However, challenges included the size and weight of the robotic system, lack of tactile feedback, and the need for specialized instruments. The long-term effects of robotic surgery on recipients remained unknown and required further research.
Overall, the review highlighted the potential of robotic surgery to enhance liver transplantation procedures, offering significant advantages while acknowledging the need for continued refinement and evaluation.
Applications
Robotic surgery has the potential to enhance liver transplantation outcomes for both donors and recipients. It can expand the donor pool by attracting more donors who prefer minimally invasive approaches and by enabling the use of complex or marginal grafts. It can also improve recipient survival and quality of life by reducing surgical trauma, complications, and the need for immunosuppression. Additionally, robotic surgery can be beneficial for training and educating transplant surgeons by providing an ergonomic environment and allowing dual-console use for supervision.
Conclusion
The review summarized that robotic surgery could be a promising tool in liver transplantation, offering greater precision and minimally invasive options. However, technical limitations, such as the size of robotic systems, lack of tactile feedback, high costs, and extensive training needs, have hindered its widespread adoption.
Therefore, continued technological advancements and detailed clinical studies could overcome these challenges and fully integrate robotic surgery into liver transplantation. The development of new robotic platforms and devices, such as haptic feedback systems and specialized instruments, could also help address these challenges and optimize the role of robotic surgery in liver transplantation.
Journal Reference
Semash, K. Robotic surgery in living liver donors and liver recipients. Laparoscopic, Endoscopic and Robotic Surgery, 2024. DOI: 10.1016/j.lers.2024.06.003, https://www.sciencedirect.com/science/article/pii/S2468900924000458
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