History and Worldwide Diffusion of Robotic Liver Surgery

Robotic surgery has revolutionized the field of minimally invasive liver surgery. Ergonomics, three-dimensional vision, improved degree of freedom and dexterity, or integration with navigation systems are some of its advantages. Current evidence supported by different meta-analyses and propensity score matching studies shows higher operative times, estimated blood loss, and costs with a lower rate of conversion to open surgery compared to laparoscopic approach. However, robotic liver surgery may still be considered in its implementation phases, and these theoretical disadvantages are not supported in individual series that have overcome this learning phase. Highly experienced groups have successfully performed extremely complex procedures such as extended resections and complex reconstructions for hilar cholangiocarcinoma or right lobe donation. The implementation of a robotic liver surgery program faces limitations such as high costs or lack of training systems. Despite initial concerns, scientific evidence supports its safety and efficacy, although cost remains a challenge. Although more studies are needed to clarify some of the limitations, both the future and the benefit to patients of robotics are promising.