The liver is one of the rare organs in your body that weighs approximately 1.5 kg and can regenerate itself. In fact, only 35-40'i of a healthy liver may be sufficient to maintain normal functions.
Hepatectomy surgery is the procedure of surgically removing a part of the liver. Today, this procedure can be performed more precisely and safely with robotic surgery techniques. Robotic liver resection is a modern approach preferred especially for the treatment of benign or malignant formations. Following this surgical intervention, which generally takes 2-6 hours, the hospital stay is on average 3-5 days.
In this article, we will explain what robotic liver resection is, in which cases it is used, and the advantages it offers you in a clear and understandable language. Staying away from medical terms, we will ensure that you get to know this important surgical method in every aspect.
What is Robotic Liver Resection?
Technological developments in the medical world open new horizons in the treatment of liver diseases. Robotic liver resection stands out as one of these innovative approaches. This method contributes to patients recovering faster by ensuring the precise removal of diseased areas in the liver.
Definition of robotic surgery
Robotic surgery is a minimally invasive surgical method in which the surgeon controls special robotic arms through a console. In this method, the doctor performs the surgery not directly on the patient, but through a computer console. The most widely used system worldwide is the Da Vinci Robotic Surgery System.
This system is equipped with a high-definition three-dimensional camera and provides surgeons with clear images of the area where the surgery will be performed. Sitting at the console, the surgeon transfers hand movements to the robotic arms, accompanied by the images seen on the screen. Thus, the robotic arms can execute the surgeon's commands precisely.
However, in robotic surgery, operations are performed by surgeons, not robots. The robot is simply a tool that copies and applies the surgeon's dexterity more precisely.
Differences from traditional surgery
There are significant differences between robotic surgery and traditional surgery. First of all, while traditional surgery requires large incisions, small incisions are made in robotic surgery. For example, in operations performed with the robotic method, 3 holes of 8 millimeters in addition to a 2-4 cm incision are sufficient.
Other important advantages of robotic surgery are:
More precise movements: The mobility of robotic arms is more sensitive and flexible than the human hand
Better imaging: The three-dimensional high-definition imaging system provides the surgeon with a more detailed view
Less blood loss: Blood loss is reduced thanks to the minimally invasive approach
Faster recovery: The patient can return to daily activities in a shorter time
Less pain: Postoperative pain is reduced thanks to small incisions
In addition, the surgeon is presented with 3D high-definition images in robotic surgery, thus providing better access to organs. Furthermore, with the feature of robot arms rotating up to 540 degrees, the surgeon can reach areas that cannot be accessed otherwise.
What is hepatectomy surgery?
Hepatectomy, also known as liver resection, is the process of surgically removing a part of the liver. Robotic liver resection is the realization of this procedure using robotic surgical systems.
Thanks to this method, surgeons can intervene in tumorous areas in the liver much more precisely. Hepatectomy surgery usually takes between 3 and 6 hours, and this duration varies depending on the size of the liver area to be removed, the location of the tumor, and the general condition of the patient.
In traditional liver transplantation, 3-4 millimeter vertical and 12-16 millimeter horizontal incisions are made just below the rib cage, whereas with robotic surgery, this procedure can be performed with much smaller incisions. This ensures that the patient suffers less pain and recovers faster.
As a result, robotic liver resection is a modern surgical approach that provides a more precise, less invasive, and faster recovery compared to traditional methods.
In Which Cases Is It Applied?
Robotic liver resection (hepatectomy) is an increasingly preferred method in the treatment of many liver disorders. This modern surgical technique offers significant advantages over classical open surgeries, especially in certain situations.
Liver cancer and metastatic tumors
The most common application area of robotic liver resection is malignant tumors. These tumors are:
Primary Liver Cancer (Hepatocellular Carcinoma): It is cancer originating from the liver's own cells and robotic surgery is an effective treatment option especially in patients without cirrhosis or with early-stage cirrhosis. It constitutes approximately 51% of the cases where robotic liver resection is performed for the treatment of malignant tumors.
Colorectal Cancer Metastases: Colon cancer most commonly spreads to the liver. With robotic surgery, both the main tumor in the colon and metastases in the liver can be cleaned, which offers patients a 40-60% 5-year survival chance. Such metastases constitute approximately 35% of cases treated with robotic surgery.
Other Organ Cancer Metastases: Limited metastases of diseases such as neuroendocrine tumors, breast and kidney cancer to the liver are also suitable for robotic surgery.
Robotic surgery is generally preferred for small and medium-sized tumors, but it can also be successfully applied in larger tumors.
Benign liver tumors
Benign liver masses are growths that do not turn into cancer and do not spread to other parts of the body. Among these are:
Hemangiomas: They are the most common benign tumors of the liver and are found in approximately 5% of adults. It is seen at a rate of 30% among benign liver masses.
Focal Nodular Hyperplasia (FNH): It is more common especially in young and middle-aged women and is seen in approximately 3-5% of the general population. It accounts for 20.5% of benign tumors.
Liver Adenomas: They are seen more frequently in women using oral contraceptives and occur at a rate of 3-4 cases per 100,000 women.
Robotic surgery can be applied when these benign tumors reach very large sizes and cause pain, create pressure, or carry a risk of bleeding.
Post-traumatic tissue damage
Robotic liver resection can also be applied in cases of severe damage to the liver resulting from traffic accidents or penetrating-cutting tool injuries. Especially in uncontrollable bleeding, robotic surgery can be a life-saving procedure.
The precise mobility offered by robotic surgery provides the opportunity for more controlled intervention to complex tissue damage occurring after trauma.
Bile duct obstructions
Bile duct cancer (cholangiocarcinoma) are tumors originating from the bile ducts within the liver. Robotic liver resection may also be required in the treatment of these tumors.
In addition, lesions causing obstruction in the bile ducts can be treated with robotic surgery. Intrahepatic liver stones can also be an indication for robotic surgery.
The integrated near-infrared fluorescence imaging feature of robotic surgery allows for better visualization of the bile ducts. Using indocyanine green (ICG), blood vessels and bile ducts can be seen more clearly, which can reduce complications during surgery.
As a result, robotic liver resection can be successfully applied in the treatment of both malignant and benign liver diseases. Factors such as the patient's general health status, the localization and size of the tumor determine suitability for this treatment method.
Surgical Planning and Evaluation Process
A successful robotic liver resection actually begins long before the patient enters the operating room. Beyond the question of what hepatectomy surgery is, carrying out a meticulous planning and evaluation process is essential for the success of this surgery. This stage is at least as important as the surgical procedure itself.
CT, MRI, and PET-CT imaging
Detailed imaging techniques are used prior to robotic liver resection. The location, spread, and relationship of the tumor with vascular structures are determined through CT (Computed Tomography) and MRI (Magnetic Resonance Imaging) imaging. In addition, thanks to these imaging methods, the volume of the liver that will remain behind after the surgery can also be calculated.
A three-dimensional map of the liver is drawn with these methods, creating a guiding plan for the surgeon. High-resolution images allow for more precise guidance of robotic arms.
PET-CT plays an important role especially in the evaluation of metastatic spread. This technique measures how much of a radioactive substance, FDG, is taken up by cells. Cancer cells absorb more FDG due to their metabolic rate and appear as bright spots on images.
PET-CT demonstrates 97% sensitivity and 75% specificity, especially in the detection of colorectal cancer metastases. Thus, the surgical team can detect metastases that might otherwise be missed before the surgery.
Liver function tests
While seeking an answer to what hepatectomy surgery is, tests performed to evaluate the postoperative functionality of the liver are of vital importance. These tests are even more critical especially if there are underlying diseases such as cirrhosis.
The Child-Pugh score is used in liver function evaluation. This score helps determine the patient's liver functions and postoperative survival risk. This evaluation is decisive in the selection of patients suitable for robotic surgery.
Patient general health status analysis
Prior to robotic liver resection, the systemic condition of the patient is also examined in detail. Heart and kidney functions, blood values, and other important parameters are evaluated.
The patient's cardiovascular system and respiratory capacity are important in determining anesthesia and surgical risks. During this evaluation, the opinions of anesthesia and cardiology specialists are obtained.
All this process ensures the creation of a personalized surgical plan. In some cases, the condition of the patients is discussed in the tumor board and the most appropriate treatment plan is determined with a multidisciplinary approach.
As a result, this comprehensive evaluation performed prior to robotic liver resection directly affects the success of the operation and allows a treatment plan tailored to the patient to be offered.
Robotic Surgery Methods and Application Process
In today's medical world, surgical procedures are constantly evolving. Hepatectomy surgery can be applied with different methods in liver surgery. Each of these methods has its own unique features.
Differences between open, laparoscopic, and robotic surgery
Liver resection can be performed with three different techniques. In open surgery, a long incision is made in the abdominal area, and surgeons intervene by directly seeing the liver. This traditional method is still used in complex cases.
In laparoscopic surgery, the procedure is carried out with a camera and special instruments inserted through small incisions. In this method, the surgeon stands at the head of the patient and works by looking at the 2-dimensional image on the monitor.
Robotic surgery is an advanced version of laparoscopy. Here, the surgeon manages the surgery sitting at a console, not next to the patient. Robotic arms provide the surgeon with a 3-dimensional and high-definition view. Additionally, robotic instruments can move at more angles (540-720 degrees) than the human hand.
Advantages of robotic systems
Robotic liver surgery offers significant superiority compared to traditional methods. First of all, the robotic system completely eliminates the surgeon's hand tremor and allows operations to be performed with millimeter precision.
The 3-dimensional imaging technology used in robotic systems gives the surgeon depth perception. This creates the opportunity to work more safely in complex liver anatomy. Furthermore, the flexibility of the robotic arms provides the opportunity to work comfortably even in narrow or hard-to-reach areas.
Other important benefits of this technology:
Less bleeding: Robotic systems can manage blood vessels more precisely
Shorter anesthesia duration: Thanks to small incisions and fast operation times
Better cosmetic results: Minimal surgical scars
Patients usually feel less pain after robotic surgery and can return to their daily lives faster.
Operation duration and hospital stay
Robotic liver resection generally takes between 2-6 hours, varying depending on the complexity of the case. In more complex cases or large resections, this duration may be prolonged. Studies in the literature show that the average robotic operation time ranges between 313 and 430 minutes.
After the surgery, patients are first monitored in the post-anesthesia unit and then taken to a regular patient room. In complex cases, the patient may need to stay in the intensive care unit for 1-2 days.
The length of hospital stay after robotic surgery is significantly shortened compared to open surgery. Patients can be discharged earlier and can start drug therapy earlier if they are to receive cancer treatment.
Ultimately, robotic liver resection provides many advantages for both surgeons and patients as today's modern surgical approach. Safe and effective results can be obtained with appropriate patient selection and an experienced surgical team.
Postoperative Recovery and Follow-up
The recovery process after robotic liver resection is a critical stage that completes the success of the surgery. Your body's recovery after hepatectomy and the liver's self-renewal process must be supported with proper care. Generally, patients stay in the hospital for the first week after surgery and then the recovery process at home begins.
Nutrition and medication use
The diet after robotic liver surgery is one of the most important factors accelerating the recovery process. The liver needs high energy while renewing itself, therefore your nutrition plan should be arranged accordingly.
First of all, you should pay attention to the following in your postoperative nutrition:
Choose foods rich in protein (eggs, lean meat, yogurt)
Eat in small and frequent portions, have 5-6 small meals a day
Drink plenty of water, try to consume at least 8-10 glasses of water a day
Stay away from fatty and fried foods
The point to be considered in drug use is that medications metabolized through the liver should not be used without doctor control. Pain relievers can usually be used safely, but you must strictly follow the doses recommended by your doctor.
Physical activity and quality of life
One of the biggest advantages of robotic surgery is that it provides faster recovery. However, mild pain, fatigue, and gas complaints in the first days after surgery are considered normal.
It is recommended that you get out of bed and move slowly within the first 24 hours after surgery. This increases blood circulation and reduces the risk of clots. Daily walks can accelerate your recovery, but you should avoid heavy lifting or strenuous physical activities for 6-8 weeks.
Generally, patients can return to normal activities within 3-4 weeks, while regaining full strength and energy can take 3-6 months.
Regular check-ups and imaging
Regular follow-ups after robotic liver resection ensure that your recovery process proceeds smoothly. You will have your first check-up appointment approximately two weeks after discharge.
In the first month, check-ups are more frequent, and then they continue periodically. Liver function tests are performed during these check-ups, and the regeneration process of your liver is evaluated.
In long-term follow-ups, imaging methods such as MRI or ultrasound are applied at 6-12 month intervals. In addition, your liver starts to reach its normal volume around the 3rd month after robotic surgery.
As a result, the recovery process after robotic liver resection is faster and more comfortable compared to traditional open surgery. Following your doctor's recommendations will accelerate your return to a healthy life after a successful hepatectomy surgery.
Robotic Liver Resection in Summary
As a result, robotic liver resection is an important treatment option offered by the modern medical world. Compared to traditional methods, this technology, which is more precise, less painful, and has a faster recovery process, has revolutionized the treatment of liver diseases.
Thanks to this surgical procedure, liver tumors, whether malignant or benign, can be removed from the body with less trauma. In addition, the superior mobility of robotic arms and 3-dimensional imaging technology provide surgeons with a precision that exceeds the limits of the human hand.
The hospital stay after robotic liver resection is as short as an average of 3-5 days. However, regaining full health may take several months. During this process, it is very important to pay attention to your nutrition, use the medications recommended by your doctor, and go for regular check-ups.
As in all surgical procedures, appropriate patient selection in robotic liver surgery is one of the most important factors affecting success. An experienced surgical team and the right technological infrastructure increase the success of the procedure.
Remember that the liver is one of the rare organs in our body that can regenerate itself. Therefore, even if you lose a part of your liver, the remaining part can grow over time and maintain normal functions. The advantages provided by robotic surgery technology support this natural healing process, increasing your quality of life and allowing you to return to your normal life faster.
Frequently Asked Questions
How long does a robotic liver surgery take? Robotic hepatectomy is usually completed between 2-6 hours. This duration varies depending on the size of the liver tissue to be removed and the location of the tumor.
How much of the liver can be safely removed? Approximately 70-75% of a healthy liver can be safely removed. The remaining healthy tissue approaches its normal size within a few months with its ability to regenerate itself.
What is the hospital stay after robotic surgery? Patients can usually be discharged within 3-5 days. This duration is quite short compared to open surgery.
Is robotic surgery suitable for every patient? No. It is preferred in selected patients based on tumor size, location, and relationship with blood vessels. Your surgeon will determine the most appropriate method for you.
What are the risks of the surgery? As with any surgical procedure, bleeding, infection, and anesthesia-related risks can be seen. In addition, system failures can occur in robotic systems at a rate of less than 1%.
What is the postoperative recovery process like? Most of the regeneration in volume takes place within the first 6-8 weeks. Reaching full functional capacity can take several months.
Does SGK cover robotic surgery? Currently, SGK does not cover robotic surgery procedures.
Robotic liver resection is a precise and safe surgical method. Used in the treatment of liver tumors, this technique provides faster recovery and less pain.
