Liver Diseases pp 785-797 | Cite as

Robotic Liver Resection

  • Amr I. Al Abbas
  • Jae Pil Jung
  • Melissa E. HoggEmail author


Robotic liver resection is an evolving approach for treatment of benign and malignant liver lesions. It offers a variety of advantages such as improved three-dimensional imaging, 540-degree movement of instruments, improved dexterity and precision in vascular dissection and intracorporeal suturing when compared to the laparoscopic approach. Perioperative outcomes of the robotic approach are comparable to those of the laparoscopic and open approaches. Long-term oncologic outcomes are also comparable. The learning curve and potential costs may hinder wide-spread implementation.


Robotic approach Operative technique Patient outcomes Learning curve Cost 


  1. 1.
    Aquina CT, Probst CP, Becerra AZ, Iannuzzi JC, Hensley BJ, Noyes K, et al. Missed opportunity: laparoscopic colorectal resection is associated with lower incidence of small bowel obstruction compared to an open approach. Ann Surg. 2016;264(1):127–34.PubMedCrossRefGoogle Scholar
  2. 2.
    Gietelink L, Wouters MW, Bemelman WA, Dekker JW, Tollenaar RA, Tanis PJ, et al. Reduced 30-day mortality after laparoscopic colorectal cancer surgery: a population based study from the Dutch surgical colorectal audit (DSCA). Ann Surg. 2016;264(1):135–40.PubMedCrossRefGoogle Scholar
  3. 3.
    McCormack K, Scott NW, Go PM, Ross S, Grant AM, Collaboration EUHT. Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev. 2003;(1):CD001785.Google Scholar
  4. 4.
    Shaligram A, Unnirevi J, Simorov A, Kothari VM, Oleynikov D. How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia. Surg Endosc. 2012;26(4):1047–50.PubMedCrossRefGoogle Scholar
  5. 5.
    Han HS, Cho JY, Yoon YS, Hwang DW, Kim YK, Shin HK, et al. Total laparoscopic living donor right hepatectomy. Surg Endosc. 2015;29(1):184.PubMedCrossRefGoogle Scholar
  6. 6.
    Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397–406; discussion –7.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Kim H, Suh KS, Lee KW, Yi NJ, Hong G, Suh SW, et al. Long-term outcome of laparoscopic versus open liver resection for hepatocellular carcinoma: a case-controlled study with propensity score matching. Surg Endosc. 2014;28(3):950–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y. Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol. 2015;63(3):643–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Nguyen KT, Geller DA. Outcomes of laparoscopic hepatic resection for colorectal cancer metastases. J Surg Oncol. 2010;102(8):975–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, et al. Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc. 2010;24(5):1170–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Vanounou T, Steel JL, Nguyen KT, Tsung A, Marsh JW, Geller DA, et al. Comparing the clinical and economic impact of laparoscopic versus open liver resection. Ann Surg Oncol. 2010;17(4):998–1009.PubMedCrossRefGoogle Scholar
  12. 12.
    Ballantyne GH. The pitfalls of laparoscopic surgery: challenges for robotics and telerobotic surgery. Surg Laparosc Endosc Percutan Tech. 2002;12(1):1–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Berguer R, Rab GT, Abu-Ghaida H, Alarcon A, Chung J. A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc. 1997;11(2):139–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Milone L, Daskalaki D, Fernandes E, Damoli I, Giulianotti PC. State of the art in robotic hepatobiliary surgery. World J Surg. 2013;37(12):2747–55.PubMedCrossRefGoogle Scholar
  15. 15.
    Packiam V, Bartlett DL, Tohme S, Reddy S, Marsh JW, Geller DA, et al. Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy. J Gastrointest Surg. 2012;16(12):2233–8.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Tsung A, Geller DA, Sukato DC, Sabbaghian S, Tohme S, Steel J, et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg. 2014;259(3):549–55.PubMedCrossRefGoogle Scholar
  17. 17.
    Giulianotti PC, Bianco FM, Daskalaki D, Gonzalez-Ciccarelli LF, Kim J, Benedetti E. Robotic liver surgery: technical aspects and review of the literature. Hepatobiliary Surg Nutr. 2016;5(4):311–21.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Giulianotti PC, Coratti A, Sbrana F, Addeo P, Bianco FM, Buchs NC, et al. Robotic liver surgery: results for 70 resections. Surgery. 2011;149(1):29–39.PubMedCrossRefGoogle Scholar
  19. 19.
    Zeh HJ III, Bartlett DL, Moser AJ. Robotic-assisted major pancreatic resection. Adv Surg. 2011;45:323–40.PubMedCrossRefGoogle Scholar
  20. 20.
    DeMatteo RP, Palese C, Jarnagin WR, Sun RL, Blumgart LH, Fong Y. Anatomic segmental hepatic resection is superior to wedge resection as an oncologic operation for colorectal liver metastases. J Gastrointest Surg. 2000;4(2):178–84.PubMedCrossRefGoogle Scholar
  21. 21.
    Poultsides GA, Schulick RD, Pawlik TM. Hepatic resection for colorectal metastases: the impact of surgical margin status on outcome. HPB (Oxford). 2010;12(1):43–9.CrossRefGoogle Scholar
  22. 22.
    Tang H, Li B, Zhang H, Dong J, Lu W. Comparison of anatomical and nonanatomical hepatectomy for colorectal liver metastasis: a meta-analysis of 5207 patients. Sci Rep. 2016;6:32304.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Zorzi D, Mullen JT, Abdalla EK, Pawlik TM, Andres A, Muratore A, et al. Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg. 2006;10(1):86–94.PubMedCrossRefGoogle Scholar
  24. 24.
    Chung JJ, Kim MJ, Kim KW. Mangafodipir trisodium-enhanced MRI for the detection and characterization of focal hepatic lesions: is delayed imaging useful? J Magn Reson Imaging. 2006;23(5):706–11.PubMedCrossRefGoogle Scholar
  25. 25.
    Hoekstra LT, de Graaf W, Nibourg GA, Heger M, Bennink RJ, Stieger B, et al. Physiological and biochemical basis of clinical liver function tests: a review. Ann Surg. 2013;257(1):27–36.PubMedCrossRefGoogle Scholar
  26. 26.
    Qiu J, Chen S, Chengyou D. A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc. 2016;30(3):862–75.PubMedCrossRefGoogle Scholar
  27. 27.
    Zureikat AH, Borrebach J, Pitt HA, McGill D, Hogg ME, Thompson V, et al. Minimally invasive hepatopancreatobiliary surgery in North America: an ACS-NSQIP analysis of predictors of conversion for laparoscopic and robotic pancreatectomy and hepatectomy. HPB (Oxford). 2017;19(7):595–602.CrossRefGoogle Scholar
  28. 28.
    Khan S, Beard RE, Kingham PT, Fong Y, Boerner T, Martinie JB, et al. Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: a multicenter study. Ann Surg Oncol. 2018;25:2652.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Berber E, Akyildiz HY, Aucejo F, Gunasekaran G, Chalikonda S, Fung J. Robotic versus laparoscopic resection of liver tumours. HPB (Oxford). 2010;12(8):583–6.CrossRefGoogle Scholar
  30. 30.
    Wang WH, Kuo KK, Wang SN, Lee KT. Oncological and surgical result of hepatoma after robot surgery. Surg Endosc. 2018;32:3918.PubMedCrossRefGoogle Scholar
  31. 31.
    Chen PD, Wu CY, Hu RH, Chou WH, Lai HS, Liang JT, et al. Robotic versus open hepatectomy for hepatocellular carcinoma: a matched comparison. Ann Surg Oncol. 2017;24(4):1021–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Kingham TP, Leung U, Kuk D, Gonen M, D’Angelica MI, Allen PJ, et al. Robotic liver resection: a case-matched comparison. World J Surg. 2016;40(6):1422–8.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Morel P, Jung M, Cornateanu S, Buehler L, Majno P, Toso C, et al. Robotic versus open liver resections: a case-matched comparison. Int J Med Robot. 2017;13(3):e1800.CrossRefGoogle Scholar
  34. 34.
    Yu YD, Kim KH, Jung DH, Namkoong JM, Yoon SY, Jung SW, et al. Robotic versus laparoscopic liver resection: a comparative study from a single center. Langenbecks Arch Surg. 2014;399(8):1039–45.PubMedCrossRefGoogle Scholar
  35. 35.
    Tranchart H, Ceribelli C, Ferretti S, Dagher I, Patriti A. Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study. World J Surg. 2014;38(11):2904–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Montalti R, Scuderi V, Patriti A, Vivarelli M, Troisi RI. Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison. Surg Endosc. 2016;30(3):1004–13.PubMedCrossRefGoogle Scholar
  37. 37.
    Chen PD, Wu CY, Hu RH, Chen CN, Yuan RH, Liang JT, et al. Robotic major hepatectomy: is there a learning curve? Surgery. 2017;161(3):642–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Efanov M, Alikhanov R, Tsvirkun V, Kazakov I, Melekhina O, Kim P, et al. Comparative analysis of learning curve in complex robot-assisted and laparoscopic liver resection. HPB (Oxford). 2017;19(9):818–24.CrossRefGoogle Scholar
  39. 39.
    Ji WB, Wang HG, Zhao ZM, Duan WD, Lu F, Dong JH. Robotic-assisted laparoscopic anatomic hepatectomy in China: initial experience. Ann Surg. 2011;253(2):342–8.PubMedCrossRefGoogle Scholar
  40. 40.
    Sham JG, Richards MK, Seo YD, Pillarisetty VG, Yeung RS, Park JO. Efficacy and cost of robotic hepatectomy: is the robot cost-prohibitive? J Robot Surg. 2016;10(4):307–13.PubMedCrossRefGoogle Scholar
  41. 41.
    Daskalaki D, Gonzalez-Heredia R, Brown M, Bianco FM, Tzvetanov I, Davis M, et al. Financial impact of the robotic approach in liver surgery: a comparative study of clinical outcomes and costs between the robotic and open technique in a single institution. J Laparoendosc Adv Surg Tech A. 2017;27(4):375–82.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Amr I. Al Abbas
    • 1
  • Jae Pil Jung
    • 1
  • Melissa E. Hogg
    • 1
    • 2
    Email author
  1. 1.University of PittsburghPittsburghUSA
  2. 2.Northshore University HealthSystemEvanstonUSA

Personalised recommendations