Advances in minimally invasive liver surgery

As in many surgical branches, minimally invasive methods are becoming increasingly prominent in hepatobiliary surgery. Nowadays, robotic and laparoscopic methods are among the hot topics in the current literature. Both laparoscopic and robotic surgery have better short-term results than open surgery in terms of the blood loss, need for blood transfusion, length of intensive care unit and hospital stay, and postoperative major complication rate. In addition to cosmetic benefits, minimally invasive methods have similar results to open surgery in terms of oncologic outcomes. Minimally invasive techniques for hepatocellular carcinoma, colorectal cancer liver metastasis and cholangiocarcinoma, which are the most common indications for surgery, also for donor and recipient surgeries in organ transplantation, can be safely applied in high-volume centers and by experienced surgeons. The use of robotic surgery is increasing especially in major hepatectomy operations. The main advantages of robotic surgery over laparoscopic surgery are less bleeding, less conversion rate and a shorter learning curve. However, there is a need for studies investigating the cost-effectiveness of robotic surgery, the production of devices such as robotic ultrasonographic dissectors, and the establishment of structured minimally invasive hepatobiliary surgery training programs. The aim of this review is to evaluate the recent findings and current evidence on minimally invasive hepatobiliary surgery.

Minimal invaziv karaciðer cerrahisinde geliþmeler

Birçok cerrahi branþta olduðu gibi, hepatobiliyer cerrahide de minimal invaziv yöntemler giderek ön plana çýkmaktadýr. Robotik ve laparoskopik yöntemler güncel literatürde en çok tartýþýlan konular arasýndadýr. Hem laparoskopik hem de robotik cerrahi, kanama miktarý, kan transfüzyonu ihtiyacý, yoðun bakým ünitesi ve hastanede kalýþ süresi ve postoperatif majör komplikasyon oraný açýsýndan açýk cerrahiye göre daha iyi kýsa dönem sonuçlara sahiptir. Kozmetik faydalarýnýn yaný sýra, minimal invaziv yöntemler onkolojik sonuçlar açýsýndan da açýk cerrahiye benzer sonuçlara sahiptir. Hepatosellüler karsinom, kolorektal kanser karaciðer metastazý, kolanjiyokarsinom, organ naklinde donör ve alýcý hepatektomiler için yüksek hacimli merkezlerde ve deneyimli cerrahlar tarafýndan minimal invaziv yöntemler güvenle uygulanabilir hale gelmiþtir. Robotik cerrahinin kullanýmý özellikle majör hepatektomi ameliyatlarý için daha yaygýndýr. Robotik cerrahinin laparoskopik cerrahiye göre baþlýca avantajlarý daha az kanama, daha düþük açýða geçme oraný ve daha kýsa öðrenme eðrisidir. Ancak robotik cerrahinin maliyet etkinliðini araþtýran çalýþmalara, robotik ultrasonografik disektör gibi cihazlarýn üretilmesine ve yapýlandýrýlmýþ minimal invaziv hepatobiliyer cerrahi eðitim programlarý oluþturulmasýna ihtiyaç vardýr. Bu derlemenin amacý minimal invaziv hepatobiliyer cerrahiye iliþkin son bulgularý ve güncel kanýtlarý deðerlendirmektir. (NCI-2024-9-4)