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Invited Critique |

Just Because You Can Doesn't Mean You Should . . . Because Many of Us Really Can’t!   Comment on “Totally Robotic Right Hepatectomy”

Matthew Cooper, MD
Arch Surg. 2011;146(7):850. doi:10.1001/archsurg.2011.130.
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Advances in surgical technique are driven by patient demand and by a genuine motivation to improve the objective and quality-of-life outcomes for those who require surgical attention. Although many would have thought (or aspired to believe) that laparoscopy was a transient interest with little to offer, it is safe to say that minimally invasive surgery is here to stay. The early experience with laparoscopic cholecystectomy and gynecological procedures led to the development of improved instrumentation, powerful optics, and training programs to allow minimally invasive therapy in cases that were thought to be reserved for open surgical management. With experience and conviction, surgeons treated various conditions in the abdominal and thoracic cavities via laparoscopy, noting its clinical benefits and technical challenges. Perhaps the last anatomical holdout was the hepatobiliary system. While appropriately feared for its risk of sudden and exhaustive hemorrhage, laparoscopic liver surgery had been reserved for excision of small exophytic lesions or resection of left lateral segments.

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