REVO

The 5th World Congress of the International Laparoscopic Liver Society (ILLS 2025) / June 26 (Thursday), 2025

From June 24 (Tuesday) to June 27 (Friday), the 5th World Congress of the International Laparoscopic Liver Society (ILLS 2025) was held at COEX in Seoul. With around 400 participants from 53 countries, the event served as a global platform for sharing the latest insights and clinical experiences in minimally invasive liver surgery and advanced surgical techniques. On the third day of the conference, Clinical Instructor Yeonsu Kim of Yonsei University College of Medicine delivered a presentation on the first case of hepatectomy using the Revo-i surgical system. Below is a summary of the key points from the session.

Revo-i is a surgical robotic system developed in South Korea. It underwent four prototype phases from 2007 to 2017 and was officially launched in 2018 under the name "Revo-i." The system was introduced at Severance Hospital in 2023 and is currently used across various surgical specialties. However, no liver surgeries had previously been performed using Revo-i in South Korea—until this case.

The featured case marks the first liver surgery using Revo-i. The patient was a 51-year-old woman with a history of hepatitis B virus carriage. During a routine health screening, she was diagnosed with intrahepatic cholangiocarcinoma located in segment 3 of the liver. At diagnosis, regional lymph node metastasis was observed, and she underwent six cycles of chemotherapy over five months. On January 22, 2025, a left lateral sectionectomy combined with lymph node dissection was performed using the Revo-i robotic system. A five-port approach was used, with four robotic ports arranged in a concave curve along the transumbilical line and one additional assistant port.

For the lymph node dissection (lymphadenectomy), Bipolar Maryland Forceps were used in the left hand and Monopolar Curved Scissors in the right. The dissection began with lymph nodes #8 and #12, which were visibly enlarged and discolored, suggesting possible metastasis.

Continued dissection of node #12 exposed the common hepatic artery, proper hepatic artery, and coronary vein. While preserving the coronary vein, dissection of nodes #7 and #9 followed, revealing the left gastric artery.

The second case involved a 69-year-old woman who had been under regular surveillance for chronic hepatitis B, during which hepatocellular carcinoma was identified in segment 5 of her liver. On May 13, 2025, a right hepatectomy was performed using Revo-i. The dissection began with the right hepatic lobe, using the same instrument setup as in the previous case: Bipolar Maryland Forceps in the left hand and Monopolar Curved Scissors in the right hand. A cholecystectomy was then performed, with the cystic duct ligated and used for traction.

Next was the hilar dissection. The right hepatic artery was first isolated and ligated using clips, followed by dissection of the right portal vein. The caudate branch was ligated using both sutures and clips. The right portal vein itself was subsequently ligated in the same manner.

After confirming the demarcation line, the liver surface was retracted using a rubber band, and parenchymal transection was initiated. During this phase, the Revo SONIC device was used on the left hand and the Bipolar Maryland Forceps on the right.

The Revo SONIC, an ultrasonic dissector, was utilized to transect the liver parenchyma, while the Bipolar Maryland Forceps were employed for dissection near major blood vessels and hemostasis.

The V5 vein, branching from segment 5 of the liver, was isolated and ligated with clips. Resection of the caudate lobe followed, during which the short hepatic veins running from the caudate lobe to the inferior vena cava (IVC) were also ligated. The bile duct was transected using a stapler. V8 was ligated with clips, and the right hepatic vein was divided in the same manner. Finally, liver mobilization was completed.

The first patient was discharged on postoperative day five, and the second on day seven, both without complications.

Several key observations emerged from the application of the Revo-i system in liver surgery. First, one of Revo-i's most significant advantages is its cost-effectiveness—it operates at a significantly lower cost compared to existing systems. Second, Revo-i serves as an independent alternative platform, promoting competition in the robotic surgery market and improving accessibility. These cases demonstrated the clinical feasibility of the Revo-i system in liver surgery and highlight its promising potential for future technological advancements.

Korean article: https://www.whosaeng.com/162964