Here is my highlight form the most recent edition of the journal HPB
Surgery is often driven by technology and liver surgery is no exception. Following the evolution of laparoscopic liver surgery it was only a matter of time before robotic liver surgical technical experience developed. One of the issues with technology is that it tends to be driven by enthusiasts and this often means that technical progress frequently outstrips scientifi c evaluation.
It is in this context that Nota and colleagues have undertaken the most comprehensive systematic review to date of robotic liver surgery, to attempt to address its place in modern liver surgery. The study used the PRISMA guidelines and includes all studies reporting 5 or more patients focusing on liver resection. Studies were assessed for quality and data were extracted to allow comparison of outcomes between easy or diffi cult access minor resections and also major resections.
The study includes 363 patients and showed good safety and feasibility in all 3 categories of resection studied. Operation times were long but conversion rates were low and length of hospital stay of patients was reasonable. Margin positivity was similar to percentages published for non-robotic techniques. The authors comment that the major advantage of robotic liver surgery may be for small relatively inaccessible resections where conventional laparoscopic resection is not feasible. They call for prospective randomized controlled trials to properly evaluate robotic surgery and while this is a laudable aspiration it may be a significant challenge to recruit patients or surgeons to such studies.