Journal of Robotic Surgery

, Volume 13, Issue 4, pp 533–538 | Cite as

Robotic hepatic surgery in malignancy: review of the current literature

  • René FahrnerEmail author
  • Falk Rauchfuß
  • Astrid Bauschke
  • Hermann Kissler
  • Utz Settmacher
  • Jürgen Zanow
Review Article


The use of minimally invasive liver surgery, such as laparoscopic and robotic surgery, is increasing worldwide. Robot-assisted laparoscopy is a new surgical technique that improves surgical handling. The advantage of this technique is improved dexterity, which leads to increased surgical precision and no tremor or fatigue. Comparable oncological results were documented for laparoscopic and open surgery. Currently, “conventional” laparoscopic liver surgery has limitations with respect to the treatment of lesions in the posterior-superior segments, and there are limited technical features for the reconstruction steps. These limitations might be overcome with the use of robotic surgery. The use of robotic surgery for hepatic procedures originated because of the technical potential to overcome several of the major technical limitations known from conventional laparoscopy and the possibility of performing more extended liver resections. Additionally, there is increasing evidence indicating that robotic hepatic surgery is feasible and safe in resections of the posterior segments. Studies showed that using the robotic technique is associated with a decreased or at least equal amount of intraoperative blood loss compared to that of the conventional laparoscopic or open technique. There is increasing evidence that robotic liver surgery might be as safe as conventional laparoscopic procedures in cancer cases in terms of resection margins, disease-free and overall survival. Furthermore, robotic surgery might be more favorable with respect to postoperative patient recovery. Despite promising results, still large, multicenter, randomized and prospective studies are needed to analyze the exact value of robotic liver surgery in patients with malignant liver tumors.


Robotic surgery Liver surgery Malignancy Learning curve Surgical technique 


Compliance with ethical standards

Conflict of interest

R. Fahrner received travel support of Biotest, F. Rauchfuss received lecture fees and travel support of Astellas, Novartis, Roche and Biotest, A. Bauschke, H. Kissler, U. Settmacher and J. Zanow have no conflict of interests.


  1. 1.
    Reich H, McGlynn F, DeCaprio J, Budin R (1991) Laparoscopic excision of benign liver lesions. Obstetr Gynecol 78:956–958Google Scholar
  2. 2.
    Azagra JS, Goergen M, Gilbart E, Jacobs D (1996) Laparoscopic anatomical (hepatic) left lateral segmentectomy—technical aspects. Surg Endosc 10:758–761CrossRefGoogle Scholar
  3. 3.
    Huscher CG, Napolitano C, Chiodini S, Recher A, Buffa PF, Lirici MM (1997) Hepatic resections through the laparoscopic approach. Annali Italiani di Chirurgia 68:791–797Google Scholar
  4. 4.
    Broeders IA (2014) Robotics: The next step? Best practice and research. Clin Gastroenterol 28:225–232Google Scholar
  5. 5.
    Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, Marsh W, Reddy SK, Bartlett DL (2014) Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg 259:549–555CrossRefGoogle Scholar
  6. 6.
    Idrees K, Bartlett DL (2010) Robotic liver surgery. Surg Clin N Am 90:761–774CrossRefGoogle Scholar
  7. 7.
    Rodrigues T, Silveira B, Tavares FP, Madeira GM, Xavier IP, Ribeiro JHC, Pereira R, Siqueira SL (2017) Open, laparoscopic, and robotic-assisted hepatectomy in resection of liver tumors: a non-systematic review. Brazil Arch Digest Surg 30:155–160Google Scholar
  8. 8.
    Tsilimigras DI, Moris D, Vagios S, Merath K, Pawlik TM (2018) Safety and oncologic outcomes of robotic liver resections: a systematic review. J Surg Oncol 117:1517–1530CrossRefGoogle Scholar
  9. 9.
    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 138:777–784CrossRefGoogle Scholar
  10. 10.
    Nota C, Molenaar IQ, van Hillegersberg R, Borel Rinkes IHM, Hagendoorn J (2016) Robotic liver resection including the posterosuperior segments: initial experience. J Surg Res 206:133–138CrossRefGoogle Scholar
  11. 11.
    Giulianotti PC, Bianco FM, Daskalaki D, Gonzalez-Ciccarelli LF, Kim J, Benedetti E (2016) Robotic liver surgery: technical aspects and review of the literature. Hepatobil Surg Nutr 5:311–321CrossRefGoogle Scholar
  12. 12.
    Croner RS, Perrakis A, Hohenberger W, Brunner M (2016) Robotic liver surgery for minor hepatic resections: a comparison with laparoscopic and open standard procedures. Langenbeck’s Arch Surg 401:707–714CrossRefGoogle Scholar
  13. 13.
    Ho CM, Wakabayashi G, Nitta H, Ito N, Hasegawa Y, Takahara T (2013) Systematic review of robotic liver resection. Surg Endosc 27:732–739CrossRefGoogle Scholar
  14. 14.
    Ji WB, Wang HG, Zhao ZM, Duan WD, Lu F, Dong JH (2011) Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg 253:342–348CrossRefGoogle Scholar
  15. 15.
    Montalti R, Berardi G, Patriti A, Vivarelli M, Troisi RI (2015) Outcomes of robotic vs laparoscopic hepatectomy: A systematic review and meta-analysis. World J Gastroenterol 21:8441–8451CrossRefGoogle Scholar
  16. 16.
    Giulianotti PC, Tzvetanov I, Jeon H, Bianco F, Spaggiari M, Oberholzer J, Benedetti E (2012) Robot-assisted right lobe donor hepatectomy. Transpl Int 25:e5–e9CrossRefGoogle Scholar
  17. 17.
    Chen PD, Wu CY, Hu RH, Ho CM, Lee PH, Lai HS, Lin MT, Wu YM (2016) Robotic liver donor right hepatectomy: a pure, minimally invasive approach. Liver Transpl 22:1509–1518CrossRefGoogle Scholar
  18. 18.
    Packiam V, Bartlett DL, Tohme S, Reddy S, Marsh JW, Geller DA, Tsung A (2012) Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastroint Surg 16:2233–2238CrossRefGoogle Scholar
  19. 19.
    Guerra F, Amore Bonapasta S, Annecchiarico M, Bongiolatti S, Coratti A (2015) Robot-integrated intraoperative ultrasound: Initial experience with hepatic malignancies. MITAT 24:345–349Google Scholar
  20. 20.
    Gonzalez-Ciccarelli LF, Quadri P, Daskalaki D, Milone L, Gangemi A, Giulianotti PC (2017) Robotic approach to hepatobiliary surgery. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 88:19–28Google Scholar
  21. 21.
    Cho CS (2016) Oncologic Hepatic Surgery: Appreciating the Landscape. The Surgical clinics of North America 96:xv-xviGoogle Scholar
  22. 22.
    Nota CL, Rinkes IHB, Hagendoorn J (2017) Setting up a robotic hepatectomy program: a Western-European experience and perspective. Hepatobil Surg Nutr 6:239–245CrossRefGoogle Scholar
  23. 23.
    Magistri P, Tarantino G, Guidetti C, Assirati G, Olivieri T, Ballarin R, Coratti A, Di Benedetto F (2017) Laparoscopic versus robotic surgery for hepatocellular carcinoma: the first 46 consecutive cases. J Surg Res 217:92–99CrossRefGoogle Scholar
  24. 24.
    Choi GH, Chong JU, Han DH, Choi JS, Lee WJ (2017) Robotic hepatectomy: the Korean experience and perspective. Hepatobil Surg Nutr 6:230–238CrossRefGoogle Scholar
  25. 25.
    Daskalaki D, Aguilera F, Patton K, Giulianotti PC (2015) Fluorescence in robotic surgery. J Surg Oncol 112:250–256CrossRefGoogle Scholar
  26. 26.
    Berardi G, Van Cleven S, Fretland AA, Barkhatov L, Halls M, Cipriani F, Aldrighetti L, Abu Hilal M, Edwin B, Troisi RI (2017) Evolution of Laparoscopic Liver Surgery from Innovation to Implementation to Mastery: Perioperative and Oncologic Outcomes of 2,238 Patients from 4 European Specialized Centers. J Am Coll Surg 225:639–649CrossRefGoogle Scholar
  27. 27.
    Scuderi V, Barkhatov L, Montalti R, Ratti F, Cipriani F, Pardo F, Tranchart H, Dagher I, Rotellar F, Abu Hilal M, Edwin B, Vivarelli M, Aldrighetti L, Troisi RI (2017) Outcome after laparoscopic and open resections of posterosuperior segments of the liver. Br J Surg 104:751–759CrossRefGoogle Scholar
  28. 28.
    Montalti R, Scuderi V, Patriti A, Vivarelli M, Troisi RI (2016) Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc 30:1004–1013CrossRefGoogle Scholar
  29. 29.
    Giulianotti PC, Coratti A, Sbrana F, Addeo P, Bianco FM, Buchs NC, Annechiarico M, Benedetti E (2011) Robotic liver surgery: results for 70 resections. Surgery 149:29–39CrossRefGoogle Scholar
  30. 30.
    Choi GH, Choi SH, Kim SH, Hwang HK, Kang CM, Choi JS, Lee WJ (2012) Robotic liver resection: technique and results of 30 consecutive procedures. Surg Endosc 26:2247–2258CrossRefGoogle Scholar
  31. 31.
    Spampinato MG, Coratti A, Bianco L, Caniglia F, Laurenzi A, Puleo F, Ettorre GM, Boggi U (2014) Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg Endosc 28:2973–2979CrossRefGoogle Scholar
  32. 32.
    Wu YM, Hu RH, Lai HS, Lee PH (2014) Robotic-assisted minimally invasive liver resection. Asian J Surg 37:53–57CrossRefGoogle Scholar
  33. 33.
    Han DH, Choi SH, Park EJ, Kang DR, Choi GH, Choi JS (2016) Surgical outcomes after laparoscopic or robotic liver resection in hepatocellular carcinoma: a propensity-score matched analysis with conventional open liver resection. MRCAS 12:735–742Google Scholar
  34. 34.
    Lee KF, Cheung YS, Chong CC, Wong J, Fong AK, Lai PB (2016) Laparoscopic and robotic hepatectomy: experience from a single centre. ANZ J Surg 86:122–126CrossRefGoogle Scholar
  35. 35.
    Lai EC, Tang CN (2016) Long-term survival analysis of robotic versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a comparative study. Surg Laparosc Endosc Percutan Tech 26:162–166CrossRefGoogle Scholar
  36. 36.
    Croner R, Perrakis A, Grutzmann R, Hohenberger W, Brunner M (2016) Robotic-assisted liver surgery. Zentralbl Chir 141:154–159CrossRefGoogle Scholar
  37. 37.
    Hu L, Yao L, Li X, Jin P, Yang K, Guo T (2017) Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms: a meta-analysis of retrospective studies. Asian J Surg 41:401–416CrossRefGoogle Scholar
  38. 38.
    Chen PD, Wu CY, Hu RH, Chen CN, Yuan RH, Liang JT, Lai HS, Wu YM (2017) Robotic major hepatectomy: Is there a learning curve? Surgery 161:642–649CrossRefGoogle Scholar
  39. 39.
    Lin CW, Tsai TJ, Cheng TY, Wei HK, Hung CF, Chen YY, Chen CM (2016) The learning curve of laparoscopic liver resection after the Louisville statement 2008: Will it be more effective and smooth? Surg Endosc 30:2895–2903CrossRefGoogle Scholar
  40. 40.
    Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102:796–804CrossRefGoogle Scholar
  41. 41.
    Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782CrossRefGoogle Scholar
  42. 42.
    O’Connor VV, Vuong B, Yang ST, DiFronzo A (2017) Robotic minor hepatectomy offers a favorable learning curve and may result in superior perioperative outcomes compared with laparoscopic approach. Am Surg 83:1085–1088Google Scholar
  43. 43.
    Chandarana M, Patkar S, Tamhankar A, Garg S, Bhandare M, Goel M (2017) Robotic resections in hepatobiliary oncology—initial experience with Xi da Vinci system in India. Indian J Cancer 54:52–55CrossRefGoogle Scholar
  44. 44.
    Lai ECH, Tang CN (2017) Training robotic hepatectomy: the Hong Kong experience and perspective. Hepatobil Surg Nutr 6:222–229CrossRefGoogle Scholar
  45. 45.
    Fernandes E, Elli E, Giulianotti P (2014) The role of the dual console in robotic surgical training. Surgery 155:1–4CrossRefGoogle Scholar
  46. 46.
    Aldrighetti L, Guzzetti E, Pulitano C, Cipriani F, Catena M, Paganelli M, Ferla G (2010) Case-matched analysis of totally laparoscopic versus open liver resection for HCC: short and middle term results. J Surg Oncol 102:82–86CrossRefGoogle Scholar
  47. 47.
    Xiong JJ, Altaf K, Javed MA, Huang W, Mukherjee R, Mai G, Sutton R, Liu XB, Hu WM (2012) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. World J Gastroenterol 18:6657–6668CrossRefGoogle Scholar
  48. 48.
    Cipriani F, Rawashdeh M, Ahmed M, Armstrong T, Pearce NW, Abu Hilal M (2015) Oncological outcomes of laparoscopic surgery of liver metastases: a single-centre experience. Updates Surg 67:185–191CrossRefGoogle Scholar
  49. 49.
    Komorowski AL, Mitus JW, Wysocki WM, Bala MM (2017) Laparoscopic and open liver resection—a literature review with meta-analysis. Arch Med Sci 13:525–532CrossRefGoogle Scholar
  50. 50.
    Troisi RI, Patriti A, Montalti R, Casciola L (2013) Robot assistance in liver surgery: a real advantage over a fully laparoscopic approach? Results of a comparative bi-institutional analysis. MRCAS 9:160–166Google Scholar
  51. 51.
    Lai EC, Yang GP, Tang CN (2013) Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205:697–702CrossRefGoogle Scholar
  52. 52.
    Patriti A, Cipriani F, Ratti F, Bartoli A, Ceccarelli G, Casciola L, Aldrighetti L (2014) Robot-assisted versus open liver resection in the right posterior section. JSLS 18Google Scholar
  53. 53.
    Mbah N, Agle SC, Philips P, Egger ME, Scoggins CR, McMasters KM, Martin RCG (2017) Laparoscopic hepatectomy significantly shortens the time to postoperative chemotherapy in patients undergoing major hepatectomies. Am J Surg 213:1060–1064CrossRefGoogle Scholar
  54. 54.
    Chen PD, Wu CY, Hu RH, Chou WH, Lai HS, Liang JT, Lee PH, Wu YM (2017) Robotic versus open hepatectomy for hepatocellular carcinoma: a matched comparison. Ann Surg Oncol 24:1021–1028CrossRefGoogle Scholar
  55. 55.
    Berber E, Akyildiz HY, Aucejo F, Gunasekaran G, Chalikonda S, Fung J (2010) Robotic versus laparoscopic resection of liver tumours. HPB 12:583–586CrossRefGoogle Scholar
  56. 56.
    Schaeff B, Paolucci V, Thomopoulos J (1998) Port site recurrences after laparoscopic surgery. A review. Digest Surg 15:124–134CrossRefGoogle Scholar
  57. 57.
    Paolucci V, Schaeff B, Schneider M, Gutt C (1999) Tumor seeding following laparoscopy: international survey. World J Surg 23:989–995; discussion 996 – 987CrossRefGoogle Scholar
  58. 58.
    Silecchia G, Perrotta N, Giraudo G, Salval M, Parini U, Feliciotti F, Lezoche E, Morino M, Melotti G, Carlini M, Rosato P, Basso N, Italian Registry of Laparoscopic Colorectal S (2002) Abdominal wall recurrences after colorectal resection for cancer: results of the Italian registry of laparoscopic colorectal surgery. Dis Colon Rect 45:1172–1177; discussion 1177CrossRefGoogle Scholar
  59. 59.
    Maarschalk J, Robinson SM, White SA (2015) Port site metastases following laparoscopic liver resection for hepatocellular carcinoma. Ann R Coll Surg Engl 97:e52–e53CrossRefGoogle Scholar
  60. 60.
    Patti JC, Ore AS, Barrows C, Velanovich V, Moser AJ (2017) Value-based assessment of robotic pancreas and liver surgery. Hepatobil Surg Nutr 6:246–257CrossRefGoogle Scholar
  61. 61.
    Sham JG, Richards MK, Seo YD, Pillarisetty VG, Yeung RS, Park JO (2016) Efficacy and cost of robotic hepatectomy: is the robot cost-prohibitive? J Robot Surg 10:307–313CrossRefGoogle Scholar
  62. 62.
    Yu YD, Kim KH, Jung DH, Namkoong JM, Yoon SY, Jung SW, Lee SK, Lee SG (2014) Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbeck’s Arch Surg 399:1039–1045CrossRefGoogle Scholar
  63. 63.
    Aselmann H, Moller T, Kersebaum JN, Egberts JH, Croner R, Brunner M, Grutzmann R, Becker T (2017) [Robot-assisted liver resection]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 88:476–483Google Scholar
  64. 64.
    Metildi CA, Kaushal S, Luiken GA, Hoffman RM, Bouvet M (2014) Advantages of fluorescence-guided laparoscopic surgery of pancreatic cancer labeled with fluorescent anti-carcinoembryonic antigen antibodies in an orthotopic mouse model. J Am Coll Surg 219:132–141CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of General, Visceral and Vascular SurgeryJena University HospitalJenaGermany

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