Minimally invasive liver resection in Japan: is the robot necessary?

Abstract

Robot-assisted hepatectomy (RAH) is rarely indicated in Japan because of the lack of reimbursement from the national health insurance system. Instead, laparoscopic hepatectomy has been approved for all hepatectomy procedures except resections requiring biliary reconstruction. An obvious advantage of RAH over laparoscopic hepatectomy is the fact that surgeons can use multi-articulated surgical devices, which may facilitate resection of superior/posterior hepatic regions, hilar dissection, biliary reconstruction, and hepatic segmentation by fluorescence imaging. With the accumulation of evidence supporting the use of robotic surgical devices in particular situations of hepatectomy, RAH will become more commonly indicated in Japan under the existing nationwide reporting system and board certification systems to assure surgical safety.

Keywords

Robot-assisted hepatectomy / laparoscopic hepatectomy / minimally invasive hepatectomy / anatomic hepatectomy / fluorescence imaging

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