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Robotic Liver Resection for Malignancies

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Minimally Invasive Surgery for Upper Abdominal Cancer

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Abstract

The benefits of minimally invasive surgery for quicker patient recovery with reduced complications are increasingly recognized, and laparoscopic abdominal surgery is now an integrated part of surgical training. Laparoscopic approaches to liver surgery have been widely adopted and are increasingly reported in the literature. Multiple studies have demonstrated the equivalency, and sometimes superiority, of perioperative parameters and short-term postoperative outcomes after laparoscopic liver surgery when compared to open liver resections, even for major hepatectomy [1–3]. A number of studies have largely allayed fears that oncologic outcomes would be compromised with a laparoscopic approach to liver surgery. Both meta-analyses and case-controlled series have shown similar rates of margin positivity, recurrence and survival when comparing laparoscopic and open liver resections for hepatocellular carcinoma (HCC) [4–6]. Likewise, laparoscopy has shown no disadvantages in regards to oncologic outcomes when used for colorectal carcinoma (CRC) liver metastases [2, 7–11]. In 2008 an international consensus conference on laparoscopic liver surgery composed the Louisville Statement, which was issued in 2009 [12]. They deduced that: (1) currently acceptable indications for laparoscopic liver surgery include solitary lesions of 5 cm or less that are located in segments 2–6, (2) laparoscopic left lateral sectionectomy should be considered standard of care, (3) major laparoscopic liver resections should be performed only by experienced surgeons, (4) conversion to open procedure should be readily considered for patient safety, long operative times and difficult resections, (5) a hand-assisted or hybrid approach may be beneficial. Importantly, however, a significant learning curve for laparoscopic liver surgery has been demonstrated, with a 45–75 cases needed for competency [13–17]. Though the feasibility, safety and oncologic efficacy of a laparoscopic approach to liver surgery are well established, the liver still presents significant technical challenges for larger anatomic resections, owing to the need for mobilization, limited space to maneuver and the complex and variant vascular and biliary anatomy.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Kaufmann Medical Building, 3471 Fifth Ave., Suite 300, Pittsburgh, PA, 15213, USA

    Rachel E. Beard, Lee M. Ocuin & Allan Tsung

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  1. Rachel E. Beard
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  2. Lee M. Ocuin
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  3. Allan Tsung
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Correspondence to Allan Tsung .

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Editors and Affiliations

  1. Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands

    Miguel A. Cuesta

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Beard, R.E., Ocuin, L.M., Tsung, A. (2017). Robotic Liver Resection for Malignancies. In: Cuesta, M. (eds) Minimally Invasive Surgery for Upper Abdominal Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-54301-7_31

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  • DOI: https://doi.org/10.1007/978-3-319-54301-7_31

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