History and Evolution of Robotic Liver Surgery

Liver surgery is one of the most technically demanding fields in general surgery due to the liver's complex vascular anatomy, fragile parenchyma, and essential physiological function. Historically, operative intervention was associated with prohibitive mortality, mainly because of uncontrollable hemorrhage and limited perioperative knowledge. This narrative review retraces the historical evolution of liver surgery from early experimental attempts to the modern era of minimally invasive procedures. Key milestones include the definition of functional liver anatomy and anatomical hepatectomy, as well as the development of techniques for bleeding control and parenchymal transection. The late 20th century marked the beginning of the modern era, driven by intraoperative ultrasound, advanced imaging, and strategies to preserve functional liver reserve. Liver transplantation further transformed the field, evolving into a standardized therapy with modern immunosuppression, graft optimization, split transplantation, and living donation. More recently, laparoscopic and robotic approaches have enabled increasingly complex resections while minimizing surgical trauma.