Letters To The Editor
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 8, 2017; 9(4): 224-226
Published online Feb 8, 2017. doi: 10.4254/wjh.v9.i4.224
Robotic liver surgery is the optimal approach as bridge to transplantation
Paolo Magistri, Giuseppe Tarantino, Roberto Ballarin, Andrea Coratti, Fabrizio Di Benedetto
Paolo Magistri, Department of Medical and Surgical Sciences and Translational Medicine, Sapienza - University of Rome, 00185 Rome, Italy
Paolo Magistri, Giuseppe Tarantino, Roberto Ballarin, Fabrizio Di Benedetto, Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy
Andrea Coratti, Department of Oncology, Division of Oncological and Robotic General Surgery, Careggi University Hospital, 50134 Florence, Italy
Author contributions: Coratti A and Di Benedetto F contributed to design and concept; Ballarin R and Tarantino G contributed to literature research and data analysis; Tarantino G and Magistri P contributed to manuscript drafting; Ballarin R, Coratti A and Di Benedetto F contributed to critically revise the manuscript.
Conflict-of-interest statement: None of the authors has conflict of interest related to this publication.
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/
Correspondence to: Paolo Magistri, MD, Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy. paolo.magistri@uniroma1.it
Telephone: +39-059-4224740 Fax: +39-059-4223765
Received: October 13, 2016
Peer-review started: October 17, 2016
First decision: November 14, 2016
Revised: November 18, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 8, 2017
Processing time: 116 Days and 7.5 Hours
Abstract

The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas (HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of: (1) the small impact on abdominal wall; (2) the gentle manipulation on the liver; (3) the limited surgical trauma; and (4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.

Keywords: Hepatocellular carcinomas; Liver transplant; Robotic surgery; Bridge to transplantation; Da vinci; Barcelona Clinic Liver Cancer; Patient safety

Core tip: We read with great interest the manuscript by Dr. Memeo et al. The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure in cirrhotic patients, and currently it deserves more direct indications that should be outlined also in the Barcelona Clinic Liver Cancer model.