Robotic Surgery of the Liver and Biliary Tract.

BACKGROUND: The laparoscopic methods for major abdominal surgery are gaining increasing acceptance worldwide. Despite its relatively recent introduction in clinical practice, robotics has been accepted as an effective option to perform high-demanding procedures such as those required in hepatobiliary surgery. Some potential advantages over conventional laparoscopy have been suggested, but its actual role in clinical practice is still to be defined.

METHODS: The objective of this work is to critically review the available evidence on the application of robotic surgery to the liver and biliary tract. PubMed, Embase, and the Cochrane Library electronic databases were systematically searched for studies reporting on robotic hepatobiliary surgery with or without comparison with open surgery or conventional laparoscopy.

RESULTS: This review provides a comprehensive snapshot of the current application of the robot to the surgery of the liver and biliary tract. The overall available data show the noninferiority of the robotic system to conventional open and laparoscopic surgery. A number of studies suggest some potential advantages in performing high-demanding procedures in a minimally invasive fashion.

CONCLUSIONS: The robot can be used to perform various types of liver surgeries quite safely and competently, although the lack of randomized control trials, comparing it with open and laparoscopic surgery, precludes the possibility to reach definitive conclusions.