Robotic liver resection: Technique and results of 30 consecutive procedures

Background: Robotic surgery can enhance a surgeon's laparoscopic skills through a magnified three-dimensional view and instruments with seven degrees of freedom compared to conventional laparoscopy. Methods: This study reviewed a single surgeon's experience of robotic liver resections in 30 consecutive patients, focusing on major hepatectomy. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed. Results: The mean age of the patients was 52.4 years and 14 were male. There were 21 malignant tumors and 9 benign lesions. There were 6 right hepatectomies, 14 left hepatectomies, 4 left lateral sectionectomies, 2 segmentectomies, and 4 wedge resections. The average operating time for the right and left hepatectomies was 724 min (range 648-812) and 518 min (range 315-763), respectively. The average estimated blood loss in the right and left hepatectomies was 629 ml (range 100-1500) and 328 ml (range 150-900), respectively. Four patients (14.8%) received perioperative transfusion. There were two conversions to open surgery (one right hepatectomy and one left hepatectomy). The overall complication rate was 43.3% (grade I, 5; grade II, 2; grade III, 6; grade IV, 0) and 40% in 20 patients who underwent major hepatectomy. Among the six (20.0%) grade III complications, a liver resection-related complication (bile leakage) occurred in two patients. The mean length of hospital stay was 11.7 days (range 5-46). There was no recurrence in the 13 patients with hepatocellular carcinoma during the median follow-up of 11 months (range 5-29). Conclusions: From our experience, robotic liver resection seems to be a feasible and safe procedure, even for major hepatectomy. Robotic surgery can be considered a new advanced option for minimally invasive liver surgery.