Augmented Reality and Image-Guided Robotic Liver Surgery

SIMPLE SUMMARY: Robotic surgery has gained much attention in liver resection for its potential to increase surgical dexterity in a minimally invasive scenario. Different series are reported in the literature with promising results, although strong evidence is lacking. In addition, the robotic system presents the advantage of creating a hybrid interface in which pre- and intra-operative imaging tools could be exploited alone or together in order to guide surgical resection. These technologies have been developed with the aim of increasing surgical safety and improving oncological results. However, some drawbacks are still present, and the literature lacks data given the relatively recent distribution of the robotic platform and of some of these technologies. ABSTRACT: Artificial intelligence makes surgical resection easier and safer, and, at the same time, can improve oncological results. The robotic system fits perfectly with these more or less diffused technologies, and it seems that this benefit is mutual. In liver surgery, robotic systems help surgeons to localize tumors and improve surgical results with well-defined preoperative planning or increased intraoperative detection. Furthermore, they can balance the absence of tactile feedback and help recognize intrahepatic biliary or vascular structures during parenchymal transection. Some of these systems are well known and are already widely diffused in open and laparoscopic hepatectomies, such as indocyanine green fluorescence or ultrasound-guided resections, whereas other tools, such as Augmented Reality, are far from being standardized because of the high complexity and elevated costs. In this paper, we review all the experiences in the literature on the use of artificial intelligence systems in robotic liver resections, describing all their practical applications and their weaknesses.