Surgical Endoscopy

, Volume 26, Issue 8, pp 2247–2258 | Cite as

Robotic liver resection: technique and results of 30 consecutive procedures

  • Gi Hong Choi
  • Sung Hoon Choi
  • Sung Hoon Kim
  • Ho Kyoung Hwang
  • Chang Moo Kang
  • Jin Sub Choi
  • Woo Jung Lee



Robotic surgery can enhance a surgeon’s laparoscopic skills through a magnified three-dimensional view and instruments with seven degrees of freedom compared to conventional laparoscopy.


This study reviewed a single surgeon’s experience of robotic liver resections in 30 consecutive patients, focusing on major hepatectomy. Clinicopathological characteristics and perioperative and short-term outcomes were analyzed.


The mean age of the patients was 52.4 years and 14 were male. There were 21 malignant tumors and 9 benign lesions. There were 6 right hepatectomies, 14 left hepatectomies, 4 left lateral sectionectomies, 2 segmentectomies, and 4 wedge resections. The average operating time for the right and left hepatectomies was 724 min (range 648–812) and 518 min (range 315–763), respectively. The average estimated blood loss in the right and left hepatectomies was 629 ml (range 100–1500) and 328 ml (range 150–900), respectively. Four patients (14.8%) received perioperative transfusion. There were two conversions to open surgery (one right hepatectomy and one left hepatectomy). The overall complication rate was 43.3% (grade I, 5; grade II, 2; grade III, 6; grade IV, 0) and 40% in 20 patients who underwent major hepatectomy. Among the six (20.0%) grade III complications, a liver resection–related complication (bile leakage) occurred in two patients. The mean length of hospital stay was 11.7 days (range 5–46). There was no recurrence in the 13 patients with hepatocellular carcinoma during the median follow-up of 11 months (range 5–29).


From our experience, robotic liver resection seems to be a feasible and safe procedure, even for major hepatectomy. Robotic surgery can be considered a new advanced option for minimally invasive liver surgery.


Robotic liver resection Major hepatectomy Technique Short-term outcomes 



The authors thank Mr. Dong-Su Jang, Research Assistant, Department of Anatomy, Yonsei University College of Medicine, Seoul, Korea, for his help with the figures. This study was supported by a faculty research grant from the Yonsei University College of Medicine for 2008 (6-2008-0128).


Gi Hong Choi, Sung Hoon Choi, Sung Hoon Kim, Ho Kyoung Hwang, Chang Moo Kang, Jin Sub Choi, and Woo Jung Lee have no conflicts of interest to disclose.


  1. 1.
    Fortner JG, Blumgart LH (2001) A historic perspective of liver surgery for tumors at the end of the millennium. J Am Coll Surg 193:210–222PubMedCrossRefGoogle Scholar
  2. 2.
    Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Corvera C, Weber S, Blumgart LH (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg 236:397–406 discussion 406–397PubMedCrossRefGoogle Scholar
  3. 3.
    Rau HG, Meyer G, Cohnert TU, Schardey HM, Jauch K, Schildberg FW (1995) Laparoscopic liver resection with the water-jet dissector. Surg Endosc 9:1009–1012PubMedCrossRefGoogle Scholar
  4. 4.
    Cuesta MA, Meijer S, Paul MA, de Brauw LM (1995) Limited laparoscopic liver resection of benign tumors guided by laparoscopic ultrasonography: report of two cases. Surg Laparosc Endosc 5:396–401PubMedGoogle Scholar
  5. 5.
    Kaneko H, Takagi S, Shiba T (1996) Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery 120:468–475PubMedCrossRefGoogle Scholar
  6. 6.
    Gugenheim J, Mazza D, Katkhouda N, Goubaux B, Mouiel J (1996) Laparoscopic resection of solid liver tumours. Br J Surg 83:334–335PubMedCrossRefGoogle Scholar
  7. 7.
    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841PubMedCrossRefGoogle Scholar
  8. 8.
    Vigano L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepatobiliary Pancreat Surg 16:410–421PubMedCrossRefGoogle Scholar
  9. 9.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS (2009) The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg 250:825–830PubMedCrossRefGoogle Scholar
  10. 10.
    Hanly EJ, Talamini MA (2004) Robotic abdominal surgery. Am J Surg 188:19S–26SPubMedCrossRefGoogle Scholar
  11. 11.
    Song J, Oh SJ, Kang WH, Hyung WJ, Choi SH, Noh SH (2009) Robot-assisted gastrectomy with lymph node dissection for gastric cancer: lessons learned from an initial 100 consecutive procedures. Ann Surg 249:927–932PubMedCrossRefGoogle Scholar
  12. 12.
    Giulianotti PC, Coratti A, Sbrana F, Addeo P, Bianco FM, Buchs NC, Annechiarico M, Benedetti E (2010) Robotic liver surgery: results for 70 resections. Surgery 149:29–39PubMedCrossRefGoogle Scholar
  13. 13.
    Ji WB, Wang HG, Zhao ZM, Duan WD, Lu F, Dong JH (2011) Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg 253:342–348PubMedCrossRefGoogle Scholar
  14. 14.
    Casciola L, Patriti A, Ceccarelli G, Bartoli A, Ceribelli C, Spaziani A (2011) Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments. Surg Endosc 25(12):3815–3824PubMedCrossRefGoogle Scholar
  15. 15.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  16. 16.
    Crothers IR, Gallagher AG, McClure N, James DT, McGuigan J (1999) Experienced laparoscopic surgeons are automated to the “fulcrum effect”: an ergonomic demonstration. Endoscopy 31:365–369PubMedCrossRefGoogle Scholar
  17. 17.
    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 250:772–782PubMedCrossRefGoogle Scholar
  18. 18.
    Idrees K, Bartlett DL (2010) Robotic liver surgery. Surg Clin North Am 90:761–774PubMedCrossRefGoogle Scholar
  19. 19.
    Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, Christidis C, Blain A, Mal F (2007) Totally laparoscopic right hepatectomy. Am J Surg 194:685–689PubMedCrossRefGoogle Scholar
  20. 20.
    Bryant R, Laurent A, Tayar C, Cherqui D (2009) Laparoscopic liver resection: understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250:103–111PubMedCrossRefGoogle Scholar
  21. 21.
    Buell JF, Thomas MT, Rudich S, Marvin M, Nagubandi R, Ravindra KV, Brock G, McMasters KM (2008) Experience with more than 500 minimally invasive hepatic procedures. Ann Surg 248:475–486PubMedGoogle Scholar
  22. 22.
    Koffron AJ, Auffenberg G, Kung R, Abecassis M (2007) Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg 246:385–392 discussion 392-384PubMedCrossRefGoogle Scholar
  23. 23.
    Chandra V, Nehra D, Parent R, Woo R, Reyes R, Hernandez-Boussard T, Dutta S (2011) A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery 147:830–839CrossRefGoogle Scholar
  24. 24.
    Stefanidis D, Wang F, Korndorffer JR Jr, Dunne JB, Scott DJ (2011) Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 24:377–382CrossRefGoogle Scholar
  25. 25.
    Kenngott HG, Muller-Stich BP, Reiter MA, Rassweiler J, Gutt CN (2008) Robotic suturing: technique and benefit in advanced laparoscopic surgery. Minim Invasive Ther Allied Technol 17:160–167PubMedCrossRefGoogle Scholar
  26. 26.
    Giulianotti PC, Sbrana F, Bianco FM, Addeo P (2010) Robot-assisted laparoscopic extended right hepatectomy with biliary reconstruction. J Laparoendosc Adv Surg Tech A 20:159–163PubMedCrossRefGoogle Scholar
  27. 27.
    Patriti A, Ceccarelli G, Bartoli A, Spaziani A, Lapalorcia LM, Casciola L (2009) Laparoscopic and robot-assisted one-stage resection of colorectal cancer with synchronous liver metastases: a pilot study. J Hepatobiliary Pancreat Surg 16:450–457PubMedCrossRefGoogle Scholar
  28. 28.
    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 138:777–784PubMedCrossRefGoogle Scholar
  29. 29.
    Wohl H (1977) The CUSUM plot: its utility in the analysis of clinical data. N Engl J Med 296:1044–1045PubMedCrossRefGoogle Scholar
  30. 30.
    Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM (2011) Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 25:855–860PubMedCrossRefGoogle Scholar
  31. 31.
    Cho JY, Han HS, Yoon YS, Shin SH (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144:32–38PubMedCrossRefGoogle Scholar
  32. 32.
    Gumbs AA, Gayet B (2008) Video: the lateral laparoscopic approach to lesions in the posterior segments. J Gastrointest Surg 12:1154PubMedCrossRefGoogle Scholar
  33. 33.
    Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048PubMedCrossRefGoogle Scholar
  34. 34.
    Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, Dagher I (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176PubMedCrossRefGoogle Scholar
  35. 35.
    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 102:82–86PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Gi Hong Choi
    • 1
    • 2
  • Sung Hoon Choi
    • 1
  • Sung Hoon Kim
    • 1
  • Ho Kyoung Hwang
    • 1
  • Chang Moo Kang
    • 1
    • 2
  • Jin Sub Choi
    • 1
    • 2
  • Woo Jung Lee
    • 1
    • 2
  1. 1.Department of SurgeryYonsei University Health SystemSeoulKorea
  2. 2.Robot & MIS Center, Severance HospitalYonsei University Health SystemSeoulKorea

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