Minimalinvasive Chirurgie und Robotik bei Lebereingriffen

Die minimalinvasive und roboterassistierte Leberchirurgie revolutioniert die Behandlung von Lebertumoren. Fortschritte in Bildgebung, Technik und Training ermöglichen komplexe Resektionen mit weniger Komplikationen. Doch trotz Hightech bleibt die Anatomie herausfordernd – und die Lernkurve ist anspruchsvoll. Ein Überblick über Status quo, Indikationen und Zukunftsperspektiven.

Schlüsselwörter

minimalinvasive Leberchirurgie - roboterassistierte Leberchirurgie - Indikationen - Diagnostik - operatives Vorgehen

• Literatur

• 1 Liu R, Wakabayashi G, Kim HJ. et al. International consensus statement on robotic hepatectomy surgery in 2018. World J Gastroenterol 2019; 25: 1432-1444
• 2 Liu R, Abu Hilal M, Wakabayashi G. et al. International experts consensus guidelines on robotic liver resection in 2023. World J Gastroenterol 2023; 29: 4815-4830
• 3 Abu Hilal M, Aldrighetti L, Dagher I. et al. The Southampton Consensus Guidelines for Laparoscopic Liver Surgery: From Indication to Implementation. Ann Surg 2018; 268: 11-18
• 4 Rahimli M, Perrakis A, Andric M. et al. Does Robotic Liver Surgery Enhance R0 Results in Liver Malignancies during Minimally Invasive Liver Surgery? – A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14: 3360
• 5 Hu J, Guo Y, Wang X. et al. Propensity Score-matched Analysis Comparing Robotic Versus Laparoscopic Minor Liver Resections of the Anterolateral Segments: an International Multi-center Study of 10,517 Cases. Ann Surg 2024;
• 6 Braunwarth E, Stättner S, Fodor M. et al. Surgical techniques and strategies for the treatment of primary liver tumours: hepatocellular and cholangiocellular carcinoma. Eur Surg 2018; 50: 100-112
• 7 Giannone F, Felli E, Cherkaoui Z. et al. Augmented Reality and Image-Guided Robotic Liver Surgery. Cancers (Basel) 2021; 13: 6268
• 8 Rahimli M, Perrakis A, Gumbs AA. et al. The LiMAx Test as Selection Criteria in Minimally Invasive Liver Surgery. J Clin Med 2022; 11: 3018
• 9 Croner RS, Gumbs AA, Perrakis A. et al. Robotic vs. laparoscopic liver surgery: what are the advantages of the robot?. Dig Med Res 2021; 4: 48
• 10 Perrakis A, Rahimli M, Gumbs AA. et al. Three-Device (3D) Technique for Liver Parenchyma Dissection in Robotic Liver Surgery. J Clin Med 2021; 10: 5265
• 11 Knitter S, Feldbrügge L, Nevermann N. et al. Robotic versus laparoscopic versus open major hepatectomy – an analysis of costs and postoperative outcomes in a single-center setting. Langenbecks Arch Surg 2023; 408: 214
• 12 Croner R, Arend J, Franz M. et al. [Robot-Assisted Right Hemi-Hepatectomy]. Zentralbl Chir 2021; 146: 235-238
• 13 Yamamoto M, Ariizumi SI. Glissonean pedicle approach in liver surgery. Ann Gastroenterol Surg 2018; 2: 124-128
• 14 Franz M, Arend J, Wolff S. et al. Tumor visualization and fluorescence angiography with indocyanine green (ICG) in laparoscopic and robotic hepatobiliary surgery – valuation of early adopters from Germany. Innov Surg Sci 2021; 6: 59-66
• 15 Xie SM, Xiong JJ, Liu XT. et al. Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases: A Comprehensive Systematic Review and Meta-analysis. Sci Rep 2017; 7: 1012
• 16 Guerrini GP, Esposito G, Tarantino G. et al. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: the first meta-analysis. Langenbecks Arch Surg 2020; 405: 265-275
• 17 Sotiropoulos GC, Prodromidou A, Kostakis ID. et al. Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. Updates Surg 2017; 69: 291-311
• 18 Mownah OA, Aroori S. The Pringle maneuver in the modern era: A review of techniques for hepatic inflow occlusion in minimally invasive liver resection. Ann Hepatobiliary Pancreat Surg 2023; 27: 131-140
• 19 Manasseh M, Davis H, Bowling K. Evaluating the Role of Indocyanine Green Fluorescence Imaging in Enhancing Safety and Efficacy During Laparoscopic Cholecystectomy: A Systematic Review. Cureus 2024; 16: e73388
• 20 Rahimli M, Gumbs AA, Perrakis A. et al. Learning curve analysis of 100 consecutive robotic liver resections. Surg Endosc 2025; 39: 2512-2522
• 21 Teoule P, Dunker N, Debatin J. et al. Reduction of Central Venous Pressure in Elective Robotic and Laparoscopic Liver Resection: The PRESSURE Trial – A Randomized Clinical Study. Ann Surg 2025;
• 22 Birgin E, Tesfazgi W, Knoth M. et al. Evaluation of the New ISGLS Definitions of Typical Posthepatectomy Complications. Scand J Surg 2019; 108: 130-136
• 23 Schnitzbauer AA, Lang SA, Goessmann H. et al. Right portal vein ligation combined with in situ splitting induces rapid left lateral liver lobe hypertrophy enabling 2-staged extended right hepatic resection in small-for-size settings. Ann Surg 2012; 255: 405-414
• 24 Heumann A, Afshar-Bakshloo K. Komplikationsmanagement in der Leberchirurgie. Allgemein- und Viszeralchirurgie up2date 2025; 19: 257-276
• 25 Fretland AA, Dagenborg VJ, Bjørnelv GMW. et al. Laparoscopic Versus Open Resection for Colorectal Liver Metastases: The OSLO-COMET Randomized Controlled Trial. Ann Surg 2018; 267: 199-207
• 26 Scalzone R, Lopez-Ben S, Figueras J. How to transect the liver? A history lasting more than a century. Dig Surg 2012; 29: 30-34
• 27 Bismuth H, Eshkenazy R, Arish A. Milestones in the evolution of hepatic surgery. Rambam Maimonides Med J 2011; 2: e0021