Key steps of complex robotic liver surgery: an international expert survey

作者：Noa L E Aegerter, Christoph Kuemmerli, Felix Nickel, Cristiano Guidetti, Christoph Tschuor, Víctor López‐López, Taiga Wakabayashi, Philipp Dutkowski, Adrian T. Billeter, Beat P. Müller‐Stich, Philip C. Müller, Complex Robotic Liver Surgery Group, Yuta Abe, Mohammad Abu Hilal, Jawad Ahmad, Luca Aldrighetti, Adnan Alseidi, Ugo Boggi, Dieter C. Bröring, Hop S. Tran Cao, Yee Lee Cheah, Roland S. Croner, Fabrizio Di Benedetto, Alessandro Ferrero, David A. Geller, Stefan Gilg, Brian K. P. Goh, Jeroen Hagendoorn, Jason Hawksworth, Jin He, Asmus Heumann, Mathieu D’Hondt, Jan Philipp Jonas, Yoshikuni Kawaguchi, Philipp Kron, Jae‐Hoon Lee, Mickaël Lesurtel, Chétana Lim, Charles Chung-Wei Lin, Georg Lurje, Marcel Cerqueira César Machado, John B. Martinie, Riccardo Memeo, Yutaka Nakano, Christian E. Oberkofler, Fabrizio Panaro, James O. Park, Hugo P. Marques, Johann Pratschke, Florian Primavesi, Nuh N. Rahbari, Francesca Ratti, Christoph Reißfelder, R Robles, Olivier Saint‐Marc, Olivier Scatton, Moritz Schmelzle, Daniel Seehofer, Olivier Soubrane, Patrick Starlinger, Stefan Stättner, B Strücker, Iswanto Sucandy, Robert P. Sutcliffe, Rutger‐Jan Swijnenburg, Christian Toso, Roberto Troisi, Go Wakabayashi, Roeland F. de Wilde · 发表于：Surgical Endoscopy · 年份：2025 · DOI：10.1007/s00464-025-12020-9 · 被引用次数：10 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Organ Transplantation Techniques and Outcomes、Liver Disease and Transplantation

BACKGROUND: Robotic liver surgery (RLS) has become the preferred minimally invasive approach for liver surgery. However, especially for complex RLS (C-RLS), key surgical steps such as preoperative preparation, intraoperative techniques, and training are often center-dependent and not standardized. The aim of this survey was to assess the international practice of key surgical steps during C-RLS among expert centers. METHODS: A cross-sectional survey was conducted among robotic liver surgeons with a minimum individual experience of 50 RLS to assess their practice during C-RLS. The survey consisted of 50 questions, distributed across three sections: training, preoperative planning, and intraoperative practice for C-RLS. RESULTS: 60 out of 71 experts completed the survey, corresponding to an 85% response rate. 73% of the experts agreed that the IWATE difficulty score represents an adequate classification system to define C-RLS. A prerequisite before performing C-RLS was experience in complex open liver surgery (71%) and expertise in low and intermediate RLS (75%). Mentoring by a more experienced surgeon was deemed necessary by most experts (90%) when performing C-RLS. Vascular inflow control was mentioned to often be performed during parenchyma transection either selectively (38%) or routinely (52%). Most experts considered pre- or intraoperative positive staining helpful (57%), while negative staining (85%) was reported as even more important in C-RLS. For vasculo-biliary trans...