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Page 2 of 3 Lo et al. Mini-invasive Surg 2022;6:36 https://dx.doi.org/10.20517/2574-1225.2022.52

Robotic surgery has been utilized in multiple centers as an alternative to the laparoscopic approach in
[5]
MIS . This was further examined in a retrospective, multi-center, international study comparing robotic-
[6]
and laparoscopic-assisted liver resection for metastatic colorectal cancer . Here, robotic surgery was used
largely for single segment or wedge resections in patients who had undergone neoadjuvant systemic therapy
prior to liver resection. There was no difference in perioperative morbidity, mortality, length of hospital
stay, readmission, or margin status. At 5-year follow-up, there was no difference in disease-free or overall
survival . These findings were recapitulated in a meta-analysis evaluating laparoscopic versus robotic liver
[6]
surgery. No difference in operative time, blood loss, conversion to open procedure, perioperative mortality,
and complication rate was noted . This suggests that robotic surgery can provide safe and comparable care
[7]
for patients when compared with laparoscopic procedures at expert centers.

The advent of laparoscopic ultrasound has been helpful in facilitating the transition from open to
laparoscopic procedures. Newer technologies such as indocyanine green (ICG) localization offer new
[8]
adjuncts for guiding anatomic minimally invasive liver surgery resections . Recent findings suggest that
ICG can be safely integrated into MIS liver procedures without adding significant operative time or safety
[9]
risk to the patient . A recent meta-analysis suggests that perioperative ICG staining can facilitate
laparoscopic anatomical liver resection using either positive or negative staining techniques .
[9]

In this special issue of MIS, we discuss topics at the frontier for minimally invasive liver surgery. These
include resection of posterior liver segments, laparoscopic ALPPS (associated liver partition and portal vein
ligation for staged hepatectomy) procedure, resection for HCC, ultrasound technique, ICG-guided
resection, and integrating robotic surgery for major hepatectomy.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the study and performed data analysis and
interpretation: Lo W, Geller DA
Performed data acquisition, as well as providing administrative, technical, and material support: Lo W,
Geller DA

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.