Guidelines
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2019; 25(12): 1432-1444
Published online Mar 28, 2019. doi: 10.3748/wjg.v25.i12.1432
International consensus statement on robotic hepatectomy surgery in 2018
Rong Liu, Go Wakabayashi, Hong-Jin Kim, Gi-Hong Choi, Anusak Yiengpruksawan, Yuman Fong, Jin He, Ugo Boggi, Roberto I Troisi, Mikhail Efanov, Daniel Azoulay, Fabrizio Panaro, Patrick Pessaux, Xiao-Ying Wang, Ji-Ye Zhu, Shao-Geng Zhang, Chuan-Dong Sun, Zheng Wu, Kai-Shan Tao, Ke-Hu Yang, Jia Fan, Xiao-Ping Chen
Rong Liu, Second Department of Hepatopancreatobiliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing 100853, China
Go Wakabayashi, Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Ageo 362-8588, Japan
Hong-Jin Kim, Department of Surgery, Yeungnam University Hospital, Daegu 705-703, South Korea
Gi-Hong Choi, Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul 03722, South Korea
Anusak Yiengpruksawan, Minimally Invasive Surgery Division, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Yuman Fong, Department of Surgery, City of Hope Medical Center, Duarte, CA 91010, United States
Jin He, Department of Surgery, the Johns Hopkins Hospital, Baltimore, MD 21287, United States
Ugo Boggi, Division of General and Transplant Surgery, Pisa University Hospital, Pisa 56124, Italy
Roberto I Troisi, Department of Clinical Medicine and Surgery, Federico II University, Naples 80131, Italy
Mikhail Efanov, Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow 11123, Russia
Daniel Azoulay, Hepato-Biliary Center, Paul Brousse University Hospital, Villejuif 94000, France
Daniel Azoulay, Hepato-Biliary Center, Tel Hashomer University Hospital, Tel Aviv, Israel
Fabrizio Panaro, Department of Surgery/Division of HBP Surgery and Transplantation, Montpellier University Hospital—School of Medicine, Montpellier 34000, France
Patrick Pessaux, Head of the Hepato-biliary and pancreatic surgical unit, Nouvel Hôpital Civil, Strasbourg Cedex 67091, France
Xiao-Ying Wang, Jia Fan, Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Ji-Ye Zhu, Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing 100044, China
Shao-Geng Zhang, Department of Hepatobiliary Surgery, 302 Hospital of Chinese PLA, Beijing 100039, China
Chuan-Dong Sun, Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266071, Shandong Province, China
Zheng Wu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Kai-Shan Tao, Department of Hepatobiliary Surgery, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
Ke-Hu Yang, Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, Gansu Province, China
Xiao-Ping Chen, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Author contributions: Members of the Consensus Steering Group: Liu R, Chen XP, Fan J and Yang KH; Members of the Consensus Development Group: Wakabayashi G, Kim HJ, Choi GH, Yiengpruksawan A, Fong Y, He J, Boggi U, Troisi RI, Efanov M, Azoulay D, Panaro F, Pessaux P, Wang XY, Zhu JH, Zhang SG, Sun CD, Wu Z, and Tao KS; all authors contributed to this article.
Supported by National Key Research and Development Program of China, No. 2017YFC0110405; and National Natural Science Foundation of China, No. 81500499.
Conflict-of-interest statement: The authors declare no conflict of interest in the development of consensus.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rong Liu, MD, PhD, Chief Doctor, Professor, Second Department of Hepatopancreatobiliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China. liurong@301hospital.com.cn
Telephone: +86-10-66937591 Fax: +86-10-66937591
Received: February 1, 2019
Peer-review started: February 1, 2019
First decision: February 13, 2019
Revised: March 6, 2019
Accepted: March 11, 2019
Article in press: March 12, 2019
Published online: March 28, 2019
Abstract

The robotic surgical system has been applied in liver surgery. However, controversies concerns exist regarding a variety of factors including the safety, feasibility, efficacy, and cost-effectiveness of robotic surgery. To promote the development of robotic hepatectomy, this study aimed to evaluate the current status of robotic hepatectomy and provide sixty experts’ consensus and recommendations to promote its development. Based on the World Health Organization Handbook for Guideline Development, a Consensus Steering Group and a Consensus Development Group were established to determine the topics, prepare evidence-based documents, and generate recommendations. The GRADE Grid method and Delphi vote were used to formulate the recommendations. A total of 22 topics were prepared analyzed and widely discussed during the 4 meetings. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method, which focused on the safety, feasibility, indication, techniques and cost-effectiveness of hepatectomy. Given that the current evidences were low to very low as evaluated by the GRADE method, further randomized-controlled trials are needed in the future to validate these recommendations.

Keywords: Minimally invasive surgery, Robotic hepatectomy, Laparoscopic hepatectomy, Hepatectomy resection, Consensus statement

Core tip: The robotic surgical system has been applied in liver surgery. Liver surgeons are also attempting to gradually expand the indications of robotic hepatectomy. To promote the development and standardization of robotic hepatectomy, we identified a group of robotic surgeon experts to provide clinical statements. Based on the published articles and expert panel opinion, 7 recommendations were generated by the GRADE method using an evidence-based method and focused on the safety, feasibility, indication, techniques and cost-effectiveness of hepatectomy. Since the current evidences were low to very low as evaluated by the GRADE method, further randomized controlled trials are needed in the future to validate these recommendations.