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Background <p>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.</p> Methods <p>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.</p> Results <p>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 transection, experts preferred an intrafascial (45%), glissonian pedicle approach (33%) or a case-dependent transection (12%). For parenchymal transection, the preferred instruments were laparoscopic CUSA (92%), harmonic ACE (78%), and SynchroSeal (77%).</p> Conclusion <p>This expert survey reveals current international practices for preoperative preparation, training, and intraoperative key steps of C-RLS. Prospective validation of the key steps would be useful for correlating clinical outcomes with current practice.</p>

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

  • 期刊论文

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  • 发表日期：

    2025年8月21日

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  • Noa L. E. Aegerter,
  • Christoph Kuemmerli,
  • Felix Nickel,
  • Cristiano Guidetti,
  • Christoph Tschuor,
  • Victor Lopez-Lopez,
  • Taiga Wakabayashi,
  • Philipp Dutkowski,
  • Adrian T. Billeter,
  • Beat P. Müller,
  • Philip C. Müller,
  • Yuta Abe,
  • Mohammad Abu Hilal,
  • Jawad Ahmad,
  • Luca Aldrighetti,
  • Adnan Alseidi,
  • Ugo Boggi,
  • Dieter C. Bröring,
  • Hop Tran Cao,
  • Yee Lee Cheah,
  • Roland Croner,
  • Fabrizio Di Benedetto,
  • Alessandro Ferrero,
  • David 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,
  • Mickael Lesurtel,
  • Chetana Lim,
  • Charles Chung-Wei Lin,
  • Georg Lurje,
  • Marcel Machado,
  • John B. Martinie,
  • Riccardo Memeo,
  • Yutaka Nakano,
  • Christian E. Oberkofler,
  • Fabrizio Panaro,
  • James Park,
  • Hugo Pinto Marques,
  • Johann Pratschke,
  • Florian Primavesi,
  • Nuh Rahbari,
  • Francesca Ratti,
  • Christoph Reissfelder,
  • Ricardo Robles-Campos,
  • Olivier Saint-Marc,
  • Olivier Scatton,
  • Moritz Schmelzle,
  • Daniel Seehofer,
  • Olivier Soubrane,
  • Patrick Starlinger,
  • Stefan Stättner,
  • Benjamin Strücker,
  • Iswanto Sucandy,
  • Roberto I. Sutcliffe,
  • Rutger-Jan Swijnenburg,
  • Christian Toso,
  • Roberto I. Troisi,
  • Go Wakabayashi,
  • Roeland de Wilde

摘要

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 transection, experts preferred an intrafascial (45%), glissonian pedicle approach (33%) or a case-dependent transection (12%). For parenchymal transection, the preferred instruments were laparoscopic CUSA (92%), harmonic ACE (78%), and SynchroSeal (77%).

Conclusion

This expert survey reveals current international practices for preoperative preparation, training, and intraoperative key steps of C-RLS. Prospective validation of the key steps would be useful for correlating clinical outcomes with current practice.