Updates in Surgery

, Volume 67, Issue 2, pp 177–183 | Cite as

Laparoscopic robot-assisted resection of tumors located in posterosuperior liver segments

  • Ugo Boggi
  • Fabio Caniglia
  • Fabio Vistoli
  • Francesca Costa
  • Erika Pieroni
  • Vittorio Grazio Perrone
Original Article
Part of the following topical collections:
  1. Minimally Invasive Liver Surgery: An Update


Laparoscopic resection of liver tumors located in the posterosuperior segments is a challenging operation that could be facilitated by robotic assistance. Laparoscopic resection of 12 tumors located in posterosuperior segments (IVa: 1; VII: 5; VIII: 6) was carried out under robotic assistance. All patients had a single tumor nodule. Data were collected prospectively and analyzed retrospectively. Surgery required a mean of 260.4 min (115–430) and was completed laparoscopically in all but one patient, who required conversion to mini-laparotomy because of intolerance of pneumoperitoneum (8.3 %). Mean estimated blood loss was 252.7 ml (50–600), making transfusion necessary in 3 patients (25.0 %). Post-operative complications occurred in 4 patients (33.3 %), being of Clavien–Dindo grade II in 3 patients (25.0 %) and Clavien–Dindo grade IV in 1 patient (8.3 %). Reoperation was required in 1 patient, who subsequently had a long hospital stay, because of decompensated cirrhosis. Median length of hospital stay was 8.5 days (7–96). No patient was readmitted. Pathology showed hepatocellular carcinoma in 7 patients (58.3 %), liver metastasis in 2 patients (16.6 %), and hepatic adenoma, focal nodular hyperplasia, and hemangioma in one patient each (8.3 %). All patients had a margin negative resection. After a mean follow-up period of 21.4 months (±24.4), no patient with malignant histology developed recurrence. Our initial experience confirms that laparoscopic robot-assisted resection of tumors located in the posterosuperior segments is feasible. Further experience is needed before final conclusions can be drawn and meaningful comparison with other surgical techniques becomes possible.


Robot da Vinci Liver Posterosuperior segments Segmentectomy Sub-segmentectomy 


Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standard

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.

Research involving human participants or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Patients were extensively counseled about their disease, the operation that was planned, and the use of robotic assistance. All patients signed an informed consent.


  1. 1.
    Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor. Surg Endosc 6:99 (abstract) Google Scholar
  2. 2.
    Hibi T, Cherqui D, Geller DA, Itano O, Kitagawa Y, Wakabayashi G (2014) International survey on technical aspects of laparoscopic liver resection: a web-based study on the global diffusion of laparoscopic liver surgery prior to the 2nd international consensus conference on laparoscopic liver resection in Iwate, Japan. J Hepatobiliary Pancreat Sci 21:737–744PubMedCrossRefGoogle Scholar
  3. 3.
    Edwin B, Mala T, Gladhaug I, Fosse E, Mathisen Y, Bergan A, Søreide O (2001) Liver tumors and minimally invasive surgery: a feasibility study. J Laparoendosc Adv Surg Tech A 11:133–139PubMedCrossRefGoogle Scholar
  4. 4.
    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 246:385–392PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection—2804 patients. Ann Surg 250:831–841PubMedCrossRefGoogle Scholar
  6. 6.
    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, World Consensus Conference on Laparoscopic Surgery (2009) The international position on laparoscopic liver surgery. The Louisville statement. Ann Surg 250:825–830PubMedCrossRefGoogle Scholar
  7. 7.
    Coles SR, Besselink MG, Serin KR, Alsaati H, Di Gioia P, Samim M, Pearce NW, Abu Hilal M (2015). Total laparoscopic management of lesions involving liver segment 7. Surg Endosc. doi: 10.1007/S00464-014-4052-2
  8. 8.
    Nomi T, Fuks D, Agrawal A, Kawaguchi Y, Ogiso S, Gayet B (2015) Totally laparoscopic right hepatectomy combined with resection of the inferior vena cava by anterior approach. Ann Surg Oncol 22:851PubMedCrossRefGoogle Scholar
  9. 9.
    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 25:3815–3824PubMedCrossRefGoogle Scholar
  10. 10.
    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection. A report from the second international consensus conference held in Morioka. Ann Surg 261:619–629PubMedGoogle Scholar
  11. 11.
    Ban D, Tanabe M, Ito H, Otsuka Y, Nitta H, Abe Y, Hasegawa Y, Katagiri T, Takagi C, Itano O, Kaneko H, Wakabayashi G (2014) A novel difficulty scoring system for laparoscopic liver resection. J Hepatobiliary Pancreat Sci 21:745–753PubMedCrossRefGoogle Scholar
  12. 12.
    Boggi U, Caniglia F, Amorese G (2014) Laparoscopic robot-assisted major hepatectomy. J Hepatobiliary Pancreat Sci 21:3–10PubMedCrossRefGoogle Scholar
  13. 13.
    Terminology Committee of the IHPBA (2000) Terminology of liver anatomy and re-sections. HPB 2:333–339Google Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Autschbach R, Onnasch JF, Falk V, Walther T, Krüger M, Schilling LO, Mohr FW (2000) The Leipzig experience with robotic valve surgery. J Card Surg 15:82–87PubMedCrossRefGoogle Scholar
  16. 16.
    Algarni KD, Suri RM, Daly RC (2014). Robotic-assisted mitral valve repair: surgical technique. Multimed Man Cardiothorac Surg. doi: 10.1093/mmcts/mmu022
  17. 17.
    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 28:2973–2979PubMedCrossRefGoogle Scholar
  18. 18.
    Boggi U, Signori S, De Lio N, Perrone VG, Vistoli F, Belluomini M, Cappelli C, Amorese G, Mosca F (2013) Feasibility of robotic pancreaticoduodenectomy. Br J Surg 100:917–925PubMedCrossRefGoogle Scholar
  19. 19.
    Waters JA, Canal DF, Wiebke EA, Dumas RP, Beane JD, Aguilar-Saavedra JR, Ball CG, House MG, Zyromski NJ, Nakeeb A, Pitt HA, Lillemoe KD, Schmidt CM (2010) Robotic distal pancreatectomy: cost effective? Surgery 148:814–823PubMedCrossRefGoogle Scholar

Copyright information

© Italian Society of Surgery (SIC) 2015

Authors and Affiliations

  • Ugo Boggi
    • 1
    • 2
  • Fabio Caniglia
    • 1
  • Fabio Vistoli
    • 1
  • Francesca Costa
    • 1
  • Erika Pieroni
    • 1
  • Vittorio Grazio Perrone
    • 1
  1. 1.Division of General and Transplant SurgeryUniversity of PisaPisaItaly
  2. 2.Azienda Ospedaliera Universitaria PisanaUniversità di PisaPisaItaly

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