Multivisceral robotic liver surgery: feasible and safe

  • Ioannis T. Konstantinidis
  • Mustafa Raoof
  • Vasilena Zheleva
  • Kelly Lafaro
  • Clayton Lau
  • Yuman Fong
  • Byrne LeeEmail author
Original Article


The application of robotic technology allows for the performance of multi-organ liver resections by multidisciplinary teams in a minimally invasive manner. Their technique and outcomes are not established. Herein we describe our technique with robotic liver surgery combined with colon, pancreas and urologic resections. Our patients are an 84-year-old (yo) female (Body Mass Index, BMI: 25) with a recently diagnosed right colon adenocarcinoma and two synchronous liver metastases at segments 5 and 6, a 75-year-old female (BMI: 50.4) with a history of right renal cell cancer status post (s/p) right robotic radical nephrectomy now with tumor recurrence with multiple intra-abdominal masses including a segment 7 liver lesion and a 71-year-old female (BMI: 24) with history of pancreatic ductal adenocarcinoma of the tail and a segment 3 liver lesion s/p neoadjuvant chemotherapy. The Xi robotic system (Intuitive Surgical, Sunnyvale, CA, USA) was utilized in all cases. Port placement in all cases was decided within the multidisciplinary teams to accommodate both the hepatic and the extra-hepatic portion of the operation. Parenchymal transections were performed with the use of the Vessel Sealer and the robotic stapler as appropriate. Indocyanine green (ICG) was used to assess the anastomotic perfusion in the first patient. Blood loss was 50 ml for the first two cases and 300 ml for the third. Surgical margins were negative in all cases. Patients were discharged at POD 8, 3 and 5 with one patient experiencing postoperative ileus. Robotic multivisceral liver resections are feasible and safe within multidisciplinary surgical teams with expertise in robotic surgery. The robotic platform can offer a minimally invasive approach in liver surgery synchronous with colonic, pancreatic and urologic surgery.


Robotic Multivisceral resections Liver surgery Minimally invasive liver surgery 




Compliance with ethical standards

Conflict of interest

Drs. Ioannis T. Konstantinidis, Mustafa Raoof, Vasilena Zheleva, Kelly Lafaro, William Chu, Clayton Lau and Byrne Lee declare that they have no conflict of interest. Dr Fong serves as Scientific advisor to Medtronics, Johnson and Johnson, Olympus, Intuitive Surgical, Perfint Robotics, Avra Robotics.

Supplementary material

Supplementary material 1 (MP4 318691 kb)


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Copyright information

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

Authors and Affiliations

  1. 1.Department of SurgeryCity of Hope National Cancer CenterDuarteUSA
  2. 2.Department of SurgeryTexas Tech University Health Sciences CenterEl PasoUSA
  3. 3.Department of SurgeryStanford UniversityStanfordUSA

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