TY - JOUR
T1 - Key steps of complex robotic liver surgery
T2 - an international expert survey
AU - Aegerter, Noa L.E.
AU - Kuemmerli, Christoph
AU - Complex Robotic Liver Surgery Group
AU - Nickel, Felix
AU - Guidetti, Cristiano
AU - Tschuor, Christoph
AU - Lopez-Lopez, Victor
AU - Wakabayashi, Taiga
AU - Dutkowski, Philipp
AU - Billeter, Adrian T.
AU - Müller, Beat P.
AU - Müller, Philip C.
AU - de Wilde, Roeland
AU - Wakabayashi, Go
AU - Troisi, Roberto I.
AU - Toso, Christian
AU - Swijnenburg, Rutger Jan
AU - Sutcliffe, Roberto I.
AU - Sucandy, Iswanto
AU - Strücker, Benjamin
AU - Stättner, Stefan
AU - Starlinger, Patrick
AU - Soubrane, Olivier
AU - Seehofer, Daniel
AU - Schmelzle, Moritz
AU - Scatton, Olivier
AU - Saint-Marc, Olivier
AU - Robles-Campos, Ricardo
AU - Reissfelder, Christoph
AU - Ratti, Francesca
AU - Rahbari, Nuh
AU - Primavesi, Florian
AU - Pratschke, Johann
AU - Marques, Hugo Pinto
AU - Park, James
AU - Panaro, Fabrizio
AU - Oberkofler, Christian E.
AU - Nakano, Yutaka
AU - Memeo, Riccardo
AU - Martinie, John B.
AU - Machado, Marcel
AU - Lurje, Georg
AU - Lin, Charles Chung Wei
AU - Lim, Chetana
AU - Lesurtel, Mickael
AU - Lee, Jae Hoon
AU - Kron, Philipp
AU - Kawaguchi, Yoshikuni
AU - Jonas, Jan Philipp
AU - He, Jin
AU - Hagendoorn, Jeroen
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/10
Y1 - 2025/10
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/105016797082
U2 - 10.1007/s00464-025-12020-9
DO - 10.1007/s00464-025-12020-9
M3 - Article
C2 - 40841593
AN - SCOPUS:105016797082
SN - 0930-2794
VL - 39
SP - 6692
EP - 6701
JO - Surgical Endoscopy
JF - Surgical Endoscopy
IS - 10
ER -