Introduction to Liver Surgery Approaches

After an initial slow diffusion of minimal invasive approaches in liver surgery, laparoscopy has now been implemented worldwide. This process has been sped up after several papers showed the superiority of laparoscopy over the open approach with regard to short-term outcomes. Before, the adaptation and diffusion of LLS was much slower compared to other general surgical specialties. The challenge in controlling major hemorrhage, the risk of gas embolism, the steepness of the learning curve and the uncertainty about oncological outcomes were barriers for the implementation of LLS. Nowadays, laparoscopic liver resections (LLR) are considered safe and feasible. The same evolution is seen in the diffusion of robotic liver surgery (RLS). The first reported robotic liver resection was published in 2003. Introduction of RLS has remained very slow compared to other subspecialties. This could be attributed to the complexity of minimally invasive liver surgery and the steep learning curve to overcome. Furthermore, the absence of instruments for parenchyma transection appeared to be a barrier for many surgeons to start RLS. Nowadays, Robotic liver surgery is in its pioneering phase and limited to a few high volume centers. Furthermore, data regarding the implementation of RLS are still scarce and the reproducibility of the implementation is still debated.

Overview of RLS

This textbook will offer readers a useful overview of RLS state of the art, collecting the contributions of renowned robotic liver surgeons from Europe, Asia and the Americas. The editors will collaborate with a professional medical illustrator specialized in minimal invasive liver surgery to offer readers a visual experience of the most important surgical steps.