Strategies to build a robotic liver surgery program

Abstract

Over the past few decades, an increasing proportion of abdominal surgeries are performed through minimally invasive platforms. In contrast, adaptation of minimally invasive techniques for liver surgery has garnered slower attraction due to the complexity and associated morbidity and mortality with these operations. Compared to laparoscopy, the robotic-assisted surgical system provides a three-dimensional operative view and instruments with articulation that mimic and extend wrist movement. These elements improve operative dexterity making dissection and suturing easier. Additionally, robotic surgery improves operative ergonomics and decreases physical and mental fatigue. Studies show that the robotic platform is safe and versatile with many technical advantages for complex operations, improved short-term outcomes compared to open surgery, and comparable oncologic outcomes. As such, hepatobiliary surgeons are increasingly adapting robotic techniques in their practice. It is crucial that as more hospitals adopt this technology, patient safety monitoring and quality initiatives are maintained. Establishing a robotic liver surgery program revolves around three pillars: designing a curriculum to overcome the learning curve, building a strong clinical and administrative team, and appropriate patient selection.