Robotic liver surgery: preliminary experience in a tertiary hepato-biliary unit

Minimally invasive liver surgery is performed with increasing frequency by hepatic surgeons. Laparoscopy was the first approach to be used and it is currently safely feasible in selected patients by experienced surgeons. Minor and major laparoscopic hepatectomies are now performed as a routine procedure in tertiary referral centers, with increasing evidence of long-term results comparable to traditional surgery together with the advantages of a minimally invasive approach. Robotic surgery, first developed for military purposes, showed to overcome some of the limits of laparoscopy, with an improved visual magnification, a 3-dimensional view and enhanced dexterity with better movement control. This allows an easier approach for resections in the posterior segments and for lesions close to major vessels. We present our preliminary experience of 20 consecutive robotic liver resection. Indications were colo-rectal liver metastasis (n = 7), hepatocellular carcinoma (n = 6), liver hemangioma (n = 2), biliary cystoadenoma (n = 2), breast cancer liver metastasis (n = 1), lung cancer liver metastasis (n = 1), symptomatic left liver lithiasis (n = 1). No conversion to laparotomy have been made and no hepatic pedicle clamping has been performed. The median duration of surgery was 141 min. There was no mortality, global morbidity was 10%. Median tumor size was 36 mm. Median post-operative length of stay was 5.7 days. Robotic surgery can be safely performed by experienced hepatic surgeons, resections of lesions in the posterior segments and close to the major vessels seem to be the best indication. Further studies are needed to clarify the exact role of robotics in liver surgery.