Updates in Surgery

, Volume 71, Issue 1, pp 129–135 | Cite as

Fully robotic left hepatectomy for malignant tumor: technique and initial results

  • Marco Vito MarinoEmail author
  • Gaspare Gulotta
  • Andrzej Lech Komorowski
Original Article


Robotic liver surgery has been considered as a unique opportunity to overcome the traditional limitations of laparoscopy; thus, it can potentially extend the indications of minimally invasive liver surgery. From April 2015 to May 2017, 35 patients underwent fully robotic left hepatectomy. The mean operative time was 315 min (200–445 min) and the mean estimated blood loss was 245 ml (125–628 ml). Pringle maneuver was required in six cases. Cancer was the indication for surgery in all patients (14 liver metastases, 18 hepatocellular carcinomas and 3 cholangiocarcinomas). There were one to four lesions in a patient and the mean lesion size was 39.2 mm (15–85 mm). The average length of hospital stay was 6.5 days (5–14 days). Perioperative morbidity rate was 17.2%. Two patients underwent conversion to open surgery. The 90-day mortality rate was nil. The mean surgical resection margin was 12 (1–22) mm, and R0-resection was reached in 33 out of 35 cases. The robotic left hepatectomy provides interesting surgical outcomes and good oncologic adequacy. It can be safely applied for the management of liver malignancies.


Minimally invasive surgery Robotic left hepatectomy Liver resection Robotic liver resection 


Compliance with ethical standards

Conflict of interest

All authors declare they have no conflict of interest or disclosures.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

An informed consent was obtained from all patients involved in the study.


  1. 1.
    Komorowski AL, Mituś JW, Wysocki WM, Bała MM (2017) Laparoscopic and open liver resection—a literature review with meta-analysis. Arch Med Sci 13(3):525–532CrossRefGoogle Scholar
  2. 2.
    Sotiropoulos GC, Prodromidou A, Kostakis ID, Machairas N (2017) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. Updates Surg 69(3):291–311CrossRefGoogle Scholar
  3. 3.
    Mirnezami R, Mirnezami AH, Chandrakumaran K, Abu Hilal M, Pearce NW, Primrose JN, Sutcliffe RP (2011) Short- and long-term outcomes after laparoscopic and open hepatic resection: systematic review and meta-analysis. HPB (Oxford) 13(5):295–308CrossRefGoogle Scholar
  4. 4.
    Fancellu A, Rosman AS, Sanna V, Nigri GR, Zorcolo L, Pisano M, Melis M (2011) Meta-analysis of trials comparing minimally-invasive and open liver resections for hepatocellular carcinoma. J Surg Res 171(1):e33–e45CrossRefGoogle Scholar
  5. 5.
    Aldrighetti L, Ratti F, Cillo U, Ferrero A, Ettorre GM, Guglielmi A, Giuliante F, Calise F, Italian group of minimally invasive liver surgery (I GO MILS) (2017) Diffusion, outcomes and implementation of minimally invasive liver surgery: a snapshot from the I Go MILS (Italian group of minimally invasive liver surgery) registry. Updates Surg 69(3):271–283CrossRefGoogle Scholar
  6. 6.
    Milone L, Daskalaki D, Fernandes E, Damoli I, Giulianotti PC (2013) State of the art in robotic hepatobiliary surgery. World J Surg 37(12):2747–2755CrossRefGoogle Scholar
  7. 7.
    Wakabayashi G, Cherqui D, Geller DA et al (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261(4):619–629Google Scholar
  8. 8.
    Patriti A, Ceccarelli G, Bartoli A, Casciola L (2011) Extracorporeal Pringle maneuver in robot-assisted liver surgery. Surg Laparosc Endosc Percutan Tech 21(5):242–244CrossRefGoogle Scholar
  9. 9.
    Nanashima A, Nagayasu T (2016) Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. Surg Today 46(4):398–404CrossRefGoogle Scholar
  10. 10.
    Qiu J, Chen S, Chengyou D (2016) A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc 30(3):862–875CrossRefGoogle Scholar
  11. 11.
    Wu YM, Hu RH, Lai HS, Lee PH (2014) Robotic-assisted minimally invasive liver resection. Asian J Surg 37(2):53–57CrossRefGoogle Scholar
  12. 12.
    Chen KH, Chen SD, Chen YD, Chang YJ, Lin TC, Siow TF, Chio UC, Huang SY, Wu JM, Jeng KS (2014) Robotic left hepatectomy with revision of hepaticojejunostomy. Asian J Surg 37(2):106–109CrossRefGoogle Scholar
  13. 13.
    Memeo R, Pisopiso V (2017) Present and future in robotic hepatectomies. Ann Laparosc Endosc Surg 2:98CrossRefGoogle Scholar
  14. 14.
    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 Gastrointest Surg 16(12):2233–2238CrossRefGoogle Scholar
  15. 15.
    Kim JK, Park JS, Han DH, Choi GH, Kim KS, Choi JS, Yoon DS (2016) Robotic versus laparoscopic left lateral sectionectomy of liver. Surg Endosc 30(11):4756–4764CrossRefGoogle Scholar
  16. 16.
    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(3):549–555CrossRefGoogle Scholar
  17. 17.
    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(1):29–39CrossRefGoogle Scholar
  18. 18.
    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(10):2973–2979CrossRefGoogle Scholar
  19. 19.
    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(8):2247–2258CrossRefGoogle Scholar
  20. 20.
    Lai EC, Yang GP, Tang CN (2013) Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205(6):697–702CrossRefGoogle Scholar
  21. 21.
    Pesi B, Moraldi L, Bartolini I, Tofani F, Guerra F, Annecchiarico M, Coratti A (2018) Pringle maneuver in robotic liver surgery: preliminary study. Minerva Chir. Google Scholar
  22. 22.
    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(4):1021–1028CrossRefGoogle Scholar
  23. 23.
    Boggi U, Caniglia F, Vistoli F, Costa F, Pieroni E, Perrone VG (2015) Laparoscopic robot-assisted resection of tumors located in posterosuperior liver segments. Updates Surg 67(2):177–183CrossRefGoogle Scholar
  24. 24.
    Lai EC, Tang CN (2014) Robot-assisted laparoscopic partial caudate lobe resection for hepatocellular carcinoma in cirrhotic liver. Surg Laparosc Endosc Percutan Tech 24(3):e88–e91CrossRefGoogle Scholar
  25. 25.
    Marino MV, Shabat G, Potapov O, Gulotta G, Komorowski AL (2018) Robotic pancreatic surgery: old concerns, new perspectives. Acta Chir Belg 8:1–8Google Scholar
  26. 26.
    Marino MV, Shabat G, Guarrasi D, Gulotta G, Komorowski AL (2018) Comparative study of the initial experience in performing robotic and laparoscopic right hepatectomy with technical description of the robotic technique. Dig Surg. Google Scholar
  27. 27.
    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(3):642–649CrossRefGoogle Scholar
  28. 28.
    Giulianotti PC, Bianco FM, Daskalaki D, Gonzalez-Ciccarelli LF, Kim J, Benedetti E (2016) Robotic liver surgery: technical aspects and review of the litterature. Hepatobiliary Surg Nutr 5(4):311–321CrossRefGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2018

Authors and Affiliations

  • Marco Vito Marino
    • 1
    Email author
  • Gaspare Gulotta
    • 2
  • Andrzej Lech Komorowski
    • 3
  1. 1.Department of Emergency and General SurgeryAzienda Ospedaliera “Villa Sofia-Cervello”Palermo (PA)Italy
  2. 2.Department of Emergency and General SurgeryPoliclinico “Paolo Giaccone”, University HospitalPalermoItaly
  3. 3.Department of Surgical OncologyMaria Sklodowska Curie Cancer Center Memorial HospitalKrakowPoland

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