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Robotic approach to hepatobiliary surgery

Roboterassistierte hepatobiliäre Chirurgie

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Abstract

Robot-assisted hepatobiliary surgery has been steadily growing in recent years. It represents an alternative to the open and laparoscopic approaches in selected patients. Endowristed instruments and enhanced visualization provide important advantages in terms of selective bleeding control, microsuturing, and dissection. Cholecystectomies and minor hepatectomies are being performed with comparable results to open and laparoscopic surgery. Even complex procedures, such as major and extended hepatectomies, can have excellent outcomes, in expert hands. The addition of indocyanine green fluorescence provides an additional advantage for recognition of the vascular and biliary anatomy. Future innovations will allow for expanding its use and indications. Robotic surgery has become a very important component of modern minimally invasive surgery and the development of new robotic technology will facilitate a broader adoption of this technique.

Zusammenfassung

Die roboterassistierte hepatobiliäre Chirurgie ist in den letzten Jahren stetig gewachsen. Sie stellt bei ausgewählten Patienten eine Alternative zu den offenen und laparoskopischen Verfahren dar. Die Endowrist-Instrumente und die verbesserte Visualisierung bieten einen wichtigen Vorteil bezüglich Blutungskontrolle, Mikronähten und Dissektion. Cholezystektomien und kleinere Hepatektomien werden mit vergleichbaren Ergebnissen durchgeführt wie offene und laparoskopische Operationen. Auch komplexe Verfahren, wie z. B. schwere und erweiterte Hepatektomien zeigen exzellente Ergebnisse, sofern sie von Experten durchgeführt werden. Der zusätzlich verwendete fluoreszierende Farbstoff Indozyaningrün bietet einen weiteren Vorteil zur Erkennung der vaskulären und biliären Anatomie. Zukünftige Innovationen werden es ermöglichen, die Anwendung und Indikationsgebiete für dieses Verfahren zu erweitern. Die roboterassistierte Operation ist zu einem sehr wichtigen Teil der modernen minimal-invasiven Chirurgie geworden, und die Entwicklung neuer Robotertechnologien werden eine breitere Anwendung dieser Technik fördern.

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Authors and Affiliations

  1. Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA

    L. F. Gonzalez-Ciccarelli MD, P. Quadri MD, D. Daskalaki MD, A. Gangemi MD, FACS & P. C. Giulianotti MD, FACS

  2. Brooklyn Hospital Center, Brooklyn, NY, USA

    L. Milone MD

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  1. L. F. Gonzalez-Ciccarelli MD
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Correspondence to P. C. Giulianotti MD, FACS.

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L. F. Gonzalez-Ciccarelli, P. Quadri, D. Daskalaki, L. Milone and  A. Gangemi have no conflicts of interest. P. C. Giulianotti is a consultant for Covidien LP. and Ethicon, Inc.; he has a proctoring agreement and Grant support as Chief of the Division.

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The German version of this article can be found under doi:10.1007/s00104-016-0249-3.

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Gonzalez-Ciccarelli, L.F., Quadri, P., Daskalaki, D. et al. Robotic approach to hepatobiliary surgery. Chirurg 88 (Suppl 1), 19–28 (2017). https://doi.org/10.1007/s00104-016-0223-0

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