Abstract
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.
Similar content being viewed by others
References
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):525–532
Sotiropoulos GC, Prodromidou A, Kostakis ID, Machairas N (2017) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. Updates Surg 69(3):291–311
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):295–308
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–e45
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):271–283
Milone L, Daskalaki D, Fernandes E, Damoli I, Giulianotti PC (2013) State of the art in robotic hepatobiliary surgery. World J Surg 37(12):2747–2755
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):619–629
Patriti A, Ceccarelli G, Bartoli A, Casciola L (2011) Extracorporeal Pringle maneuver in robot-assisted liver surgery. Surg Laparosc Endosc Percutan Tech 21(5):242–244
Nanashima A, Nagayasu T (2016) Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. Surg Today 46(4):398–404
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):862–875
Wu YM, Hu RH, Lai HS, Lee PH (2014) Robotic-assisted minimally invasive liver resection. Asian J Surg 37(2):53–57
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):106–109
Memeo R, Pisopiso V (2017) Present and future in robotic hepatectomies. Ann Laparosc Endosc Surg 2:98
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):2233–2238
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):4756–4764
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):549–555
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):29–39
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):2973–2979
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):2247–2258
Lai EC, Yang GP, Tang CN (2013) Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome. Am J Surg 205(6):697–702
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. https://doi.org/10.23736/S0026-4733.18.07599-5
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):1021–1028
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):177–183
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–e91
Marino MV, Shabat G, Potapov O, Gulotta G, Komorowski AL (2018) Robotic pancreatic surgery: old concerns, new perspectives. Acta Chir Belg 8:1–8
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. https://doi.org/10.1159/000487686
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):642–649
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):311–321
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Rights and permissions
About this article
Cite this article
Marino, M.V., Gulotta, G. & Komorowski, A.L. Fully robotic left hepatectomy for malignant tumor: technique and initial results. Updates Surg 71, 129–135 (2019). https://doi.org/10.1007/s13304-018-0560-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-018-0560-2