Dr Sucandy Edited and Published a Textbook of Robotic Liver Surgery. A Start of The New Era in Minimally Invasive Liver Surgery Worldwide
The field of robotic surgery is expanding rapidly in the last five years, ranging from gastrointestinal, hernia, bariatric (weight loss), colorectal, and now hepatobiliary surgery subspecialties. Liver and biliary surgery specialists are the last to adopt due to their difficult nature of those surgeries as evidenced by the need for high precision, rapid bleeding control, and vascular reconstruction that are often needed without exact preoperative planning. As a result of these higher technical complexity compared to other operations, robotic liver surgery is relatively still at its infancy. More than 90% of liver resections worldwide are still performed through a traditional open surgery. This requires rib retraction and aggressive exposure to gain access into the liver including its surrounding vessels such as inferior vena cava, hepatic artery and portal vein. This operation is considered one of the most aggressive with significant potential postoperative complications.
Training, Education, and Traditional Culture of Liver Surgery
Liver surgery and transplantation are typically undertaken only at major academic centers or large-size hospital with strong supports of interventional radiology, gastroenterology and Intensive Care Unit Team. In the 1980, major liver surgery is considered a very dangerous operation with a high rate of intra-/postoperative death (up to 20-30%) due to major uncontrollable bleeding. This fact led to liver surgery being considered only for the best and the most skilled male surgeons “the boys” to undertake. In the field of liver surgery and transplantation, it is extremely rare to find women surgeons, even today. The conventional training model is typically done through apprenticeship since formal training in liver surgery was uncommon, mostly due to lack of competent teachers. For many decades in the United States, liver surgery is done via the open surgery and the ‘newer’ laparoscopic surgery is considered by many pioneers as unsafe. There were many debates among liver surgeons in the past five years as to what the best technique to perform major liver surgery.
The Need for Education in Robotic Liver Surgery
Since the first randomized trial comparing open vs minimally invasive liver resection published by team from Oslo University Hospital, adoption of laparoscopic and robotic liver surgery is gradually increasing. Robotic surgery workshop, case observations and online webinars are highly sought after. Dr Sucandy with his colleague Dr Dhondt started to organize robotic liver surgery cadaver courses to help others learn this new modern technique to improve patient’s outcomes. These courses were help in Orlando by Dr Sucandy at Nicholson Center, Houston Methodist, ORSI Academy in Belgium and Intuitive training labs in Altanta GA. In these courses, technique of vascular dissection, liver division, bleeding control, and tricks to avoid conversion were all discussed in detail. Dr Sucandy, Dr Dhondt and other colleagues ultimately decided to undertake the writing of Robotic Liver Surgery Textbook to help other learn the techniques of robotic liver surgery, since such a textbook is non-existent. Springer Verlag was chosen to be the publisher, one of the most experienced companies in surgical education in the past 50 years.
About the Textbook of Robotic Liver Surgery
The textbook of Robotic Liver contains 32 chapters contributed by all the top pioneers in the world. The true masters in this subspecialty from Asia, America, Europe, and Middle-East came together to share their approaches in many different types of liver resections, ranging from colorectal liver metastases resection, bile duct cancer resection, to living donor hepatectomy for liver transplantation. More than 100 surgical photos were manually illustrated by a medical illustrator from Belgium to enhance technical clarity of key steps in the operation. Additional chapters such as liver ultrasounds, radiology/imaging software for volumetric measurement in preparation for liver surgery, anesthesia for liver surgery, and liver surgery for benign tumors were also included. The textbook had been finalized and submitted for production at this stage and it is expected to reach its readers in February 2025. Dr Sucandy hopes that this Textbook will be the landmark publication in the new era of robotic liver surgery and will continue to improve the quality/outcomes of liver surgery worldwide.
