Karaciğer Hastalıklarında Minimal İnvaziv Cerrahi
Synopsis
Karaciğer hastalıklarında minimal invaziv cerrahi, son yıllarda teknolojik gelişmeler ve artan cerrahi deneyim sayesinde hepatobiliyer cerrahinin temel uygulama alanlarından biri haline gelmiştir. Laparoskopik ve robotik yaklaşımlar; daha az postoperatif ağrı, kısa hastanede kalış süresi, düşük kan kaybı ve daha hızlı iyileşme gibi önemli perioperatif avantajlar sağlamaktadır. Günümüzde majör hepatektomiler, kompleks anatomik rezeksiyonlar, canlı donör hepatektomileri ve seçilmiş karaciğer transplantasyonu olguları minimal invaziv yöntemlerle güvenli şekilde uygulanabilmektedir. Robotik cerrahi sistemleri; üç boyutlu görüntüleme, gelişmiş enstrüman hareket kabiliyeti ve ergonomik avantajlar sayesinde cerrahi hassasiyeti artırmaktadır. Bunun yanında yapay zekâ destekli görüntüleme sistemleri ve navigasyon teknolojileri, gelecekte minimal invaziv karaciğer cerrahisinin daha da yaygınlaşmasına katkı sağlayacaktır. Bu bölümde laparoskopik ve robotik karaciğer cerrahisinin güncel endikasyonları, onkolojik sonuçları, transplantasyon uygulamaları, ALPPS yaklaşımı ve öğrenme eğrisi ile ilgili güncel literatür eşliğinde kapsamlı bir değerlendirme sunulmaktadır.
Minimally invasive liver surgery has become one of the major fields of hepatobiliary surgery owing to significant technological advances and increasing surgical experience over the past decades. Laparoscopic and robotic approaches provide important perioperative advantages, including reduced postoperative pain, shorter hospital stay, lower blood loss, and faster recovery. Today, major hepatectomies, complex anatomical resections, living donor hepatectomies, and selected liver transplantation procedures can be safely performed using minimally invasive techniques. Robotic surgical systems enhance surgical precision through high-definition three-dimensional visualization, improved instrument dexterity, and ergonomic advantages. Furthermore, the integration of artificial intelligence–based navigation and imaging technologies is expected to further expand the role of minimally invasive liver surgery in the future. This chapter provides a comprehensive overview of current laparoscopic and robotic liver surgery, including oncological outcomes, minimally invasive transplantation, ALPPS procedures, and learning curve assessment in light of the contemporary literature.
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