Professor Giulio Belli
General and HepatoPancreatoBiliary Surgery, Loreto Nuovo Hospital, Naples, Italy.
Special Issue Introduction
During the last decade, progress in preoperative patient assessment, refinement of the indications for resection, improved surgical technique and the development of new surgical devices have greatly enhanced the safety of minimal invasive HPB (mHPB) surgery. Therefore, a minimally invasive approach is currently widely applied with selected indications in highly specialized HPB centres worldwide. Several non-randomized studies and meta-analyses suggested that mHPB surgery could improve the short-term postoperative outcomes by reducing the intraoperative blood loss and the postoperative morbidity when compared to a standard open approach. mHPB surgery also seems to promote an earlier recovery and a reduction in the length of postoperative stays when compared to an open approach without affecting the oncologic outcomes. Therefore, the diffusion of mHPB surgery is increasing and a minimally invasive approach seems to be generally recognized as a suitable approach. With this premises, robotic HPB (rHPB) surgery seems to have the potentiality to be further evolved in the filed of mHPB surgery. The robotic platform was introduced with the aim to overcome the drawbacks of the conventional laparoscopic approach. Advantages of the robotic approach are mainly related to magnified high-resolution 3D view and the higher dexterity achievable with the robotic instruments thanks to seven degrees of freedom of the endowrist system. The use of the surgical robot could also facilitate technically complex cases, which has been reported to have an impact on the reduction of conversion rate to open surgery. Robotic surgery also seems to facilitate and speed up the learning curve especially in surgeons not previously trained in laparoscopic surgery. Nevertheless, the role and the potentiality (in terms of improved clinical outcomes) of the robotic approach in HPB surgery have not been clearly addressed yet. In addition there is an ongoing debate on the cost-effectiveness of the robotic approach and whether the higher costs associated to the robotic platform (mainly related to longer operative time and the costs of surgical material), could be balanced by better short-term clinical outcomes and by a shorter hospital stay. In this Special Issue of MIS, focused on rHPB surgery, the challenges of this rapidly developing field will be addressed. Technical aspects related with the use of robotic assistance for both liver and pancreatic surgery will be extensively discussed. Each contributor will discuss and highlight both limits and advantages of the robotic approach in his specific field. The authors will discuss their technique and their results where possible. The contributors of this issue will give an important contribution in defining the current role of the robotic approach in HPB surgery. I am very pleased and sincerely grateful to all of the authors for their outstanding effort in contributing to this issue.
30 Jun 2020