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Page 4 of 6 Cassese et al. Hepatoma Res 2022;8:24 https://dx.doi.org/10.20517/2394-5079.2022.15

[57]
a specific review published in this Special Issue by Sioutas et al. . Sadly, the lack of specific instruments
such as CUSA and the high cost of the devices, as well as logistic and organizational aspects, continue to
represent obstacles to the widespread adoption of robotic surgery.

Finally, important advances in medical therapy are playing an important role in changing the whole
therapeutic scenario. In particular, the combination of tyrosine-kinase inhibitors and anti-PD-1 antibodies
has been shown to be a feasible conversion therapy for patients with unresectable HCC to become
resectable . Even if further studies are needed, these first results seem to suggest the possibility of further
[58]
expanding the indications for surgical resection to more and more patients, with the possible role of MILS
still to be clarified.

The technological surgical revolution has undoubtedly transformed surgery, from the knowledge of liver
anatomy, through surgical planning, to new technical approaches. Despite all improvements, MILS is still
considered a difficult procedure because of some technical limits, especially for challenging situations such
as difficult positions or repeat resections . In this light, this Special Issue focusing on the current role of
[59]
“Minimally invasive surgery for HCC” shows interesting advances in MILS, including LLR and RLR, with
particular regard to the latest literature evidence and experiences about the use of novel technologies in this
setting.

In conclusion, the quality of the surgery itself has greatly benefited from the minimally invasive approach,
allowing to obtain a better visualization that also represents a fundamental didactic value for young
surgeons. Hepato-biliary surgery today can no longer stand without the minimally invasive approach.

DECLARATIONS
Authors’ contributions
Make substantial contributions to conception of the study, as well as provid administrative, technical, and
material support: Cassese G, Han HS

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2022.