Robotic liver surgery: enhancing immune competence and minimizing postsurgical inflammation

In recent years, more complex robotic-assisted liver resections (RLR) have been performed, providing a viable alternative to open liver resection (OLR). While the short-term benefits of minimally invasive surgery are well known, including reduced blood loss and shorter hospital stay, the inflammatory response to different surgical approaches remains poorly understood.

This study examines the immune response in peripheral blood and local liver and peritoneal tissue during and after liver surgery in 22 patients (11 in each group). The study analyzes clinical and laboratory parameters, leukocyte activation, and cytokine/chemokine levels before and after liver parenchyma dissection using L-selectin shedding assay and FACS multiplex analysis panel.

In the perioperative course, systemic and local liver cytokine levels of IL-6 and IL-10 are reduced in RLR. The laparotomy itself resulted in higher baseline levels of IL-6, IL-8, CXCL10, IFNγ, TGFβ1, and IL-1β in local liver tissue of the OLR group. After liver parenchyma dissection, RLR patients exhibited reduced levels of IL-6, IL-8, IFNγ, MCP1, IL-1β, TGFβ1, and CXCL10 in the liver compared to the OLR group. In the late postoperative course from postoperative day (POD) 5-20, systemic chemokine MCP1 was reduced, alongside a decrease of CD4⁺/CD8⁺ lymphocytes and higher L-selectin shedding capacity in the RLR group from POD5 onwards.

These findings suggest that RLR preserves immune competence more effectively than OLR in the peri- and late postoperative course. The reduced systemic and local inflammatory response may be the result of less tissue damage with reduced cytokine release, highlighting the value of less traumatic surgery applied by robotic systems during clinical practice.