Robotic Hepatic Resections: Segmentectomy, Lobectomy, Parenchymal Sparing

  • M. Shirin Sabbaghian
  • David L. Bartlett
  • Allan TsungEmail author


Robotic assistance offers several advantages for certain surgical procedures. Its use has been and is being investigated for its application in liver resection. This chapter describes how we use robotic assistance for hepatic resection.


Liver Resection Hepatic Vein Robotic Assistance Falciform Ligament Camera Port 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to acknowledge Randal McKenzie/McKenzie Illustrations for figures 2–10.


  1. 1.
    Langenbuch D. Ein fall von resektion eines linksseitigen schnurlappens der leber. Heilung Berl Klin Wochenschr. 1888;25:37–8.Google Scholar
  2. 2.
    Couinaud C, editor. Etudes anatomiques et chirurgicales. Paris: Masson; 1957.Google Scholar
  3. 3.
    Cantlie J. On a new arrangement of the right and left lobes of the liver. J Anat Physiol. 1897;32:4–9.Google Scholar
  4. 4.
    Hjortsjo CH. The topography of the intrahepatic duct systems. Acta Anat (Basel). 1951;11(4):599–615.CrossRefGoogle Scholar
  5. 5.
    McIndoe AH, Counsellor V. The bilaterality of the liver. Arch Surg. 1927;15:589–612.CrossRefGoogle Scholar
  6. 6.
    Fortner JG, Shiu MH, Kinne DW, Kim DK, Castro EB, Watson RC, et al. Major hepatic resection using vascular isolation and hypothermic perfusion. Ann Surg. 1974;180(4):644–52.CrossRefPubMedGoogle Scholar
  7. 7.
    Huguet C, Nordlinger B, Bloch P, Conard J. Tolerance of the human liver to prolonged normothermic ischemia. A biological study of 20 patients submitted to extensive hepatectomy. Arch Surg. 1978;113(12):1448–51.CrossRefPubMedGoogle Scholar
  8. 8.
    Huguet C, Nordlinger B, Galopin JJ, Bloch P, Gallot D. Normothermic hepatic vascular exclusion for extensive hepatectomy. Surg Gynecol Obstet. 1978;147(5):689–93.PubMedGoogle Scholar
  9. 9.
    Kousnetzoff M, Pensky J. Sur la resection partielle du foie. Rev Chir. 1896;16:954–92.Google Scholar
  10. 10.
    Melendez JA, Arslan V, Fischer ME, Wuest D, Jarnagin WR, Fong Y, et al. Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg. 1998;187(6):620–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Pringle JH. V. Notes on the arrest of hepatic hemorrhage due to trauma. Ann Surg. 1908;48(4):541–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Bismuth H, Castaing D, Garden OJ. The use of operative ultrasound in surgery of primary liver tumors. World J Surg. 1987;11(5):610–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Castaing D, Kunstlinger F, Habib N, Bismuth H. Intraoperative ultrasonographic study of the liver. Methods and anatomic results. Am J Surg. 1985;149(5):676–82.CrossRefPubMedGoogle Scholar
  14. 14.
    Fong Y, Blumgart LH. Useful stapling techniques in liver surgery. J Am Coll Surg. 1997;185(1):93–100.CrossRefPubMedGoogle Scholar
  15. 15.
    Geller DA, Tsung A, Maheshwari V, Rutstein LA, Fung JJ, Marsh JW. Hepatic resection in 170 patients using saline-cooled radiofrequency coagulation. HPB (Oxford). 2005;7(3):208–13.CrossRefGoogle Scholar
  16. 16.
    Saiura A, Yamamoto J, Koga R, Sakamoto Y, Kokudo N, Seki M, et al. Usefulness of LigaSure for liver resection: analysis by randomized clinical trial. Am J Surg. 2006;192(1):41–5.CrossRefPubMedGoogle Scholar
  17. 17.
    Weber JC, Navarra G, Jiao LR, Nicholls JP, Jensen SL, Habib NA. New technique for liver resection using heat coagulative necrosis. Ann Surg. 2002; 236(5):560–3.CrossRefPubMedGoogle Scholar
  18. 18.
    Belghiti J, Hiramatsu K, Benoist S, Massault P, Sauvanet A, Farges O. Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg. 2000;191(1):38–46.CrossRefPubMedGoogle Scholar
  19. 19.
    Dimick JB, Pronovost PJ, Cowan Jr JA, Lipsett PA. Postoperative complication rates after hepatic resection in Maryland hospitals. Arch Surg. 2003; 138(1):41–6.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Cai XJ, Yang J, Yu H, Liang X, Wang YF, Zhu ZY, et al. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors. Surg Endosc. 2008;22(11):2350–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Koffron AJ, Auffenberg G, Kung R, Abecassis M. Evaluation of 300 minimally invasive liver resections at a single institution: less is more. Ann Surg. 2007;246(3):385–92. discussion 92–4.CrossRefPubMedGoogle Scholar
  23. 23.
    Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg. 2009;250(5):831–41.CrossRefPubMedGoogle Scholar
  24. 24.
    Kwoh YS, Hou J, Jonckheere EA, Hayati S. A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng. 1988;35(2):153–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Satava RM. Robotic surgery: from past to future–a personal journey. Surg Clin North Am. 2003;83(6): 1491–500. xii.CrossRefPubMedGoogle Scholar
  26. 26.
    Chan OC, Tang CN, Lai EC, Yang GP, Li MK. Robotic hepatobiliary and pancreatic surgery: a cohort study. J Hepatobiliary Pancreat Sci. 2011;18(4): 471–80.CrossRefPubMedGoogle Scholar
  27. 27.
    Ryska M, Fronek J, Rudis J, Jurenka B, Langer D, Pudil J. Manual and robotic laparoscopic liver resection. Two case-reviews. Rozhl Chir. 2006;85(10): 511–6.PubMedGoogle Scholar
  28. 28.
    Kitisin K, Packiam V, Bartlett DL, Tsung A. A current update on the evolution of robotic liver surgery. Minerva Chir. 2011;66(4):281–93.PubMedGoogle Scholar
  29. 29.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, et al. The international position on laparoscopic liver surgery: the Louisville Statement, 2008. Ann Surg. 2009;250(5):825–30.CrossRefPubMedGoogle Scholar
  30. 30.
    Abood GJ, Tsung A. Robotic-assisted surgery: improved tool for major liver resections? J Hepatobiliary Pancreat Sci. 2013;20(2):151–6.CrossRefPubMedGoogle Scholar
  31. 31.
    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
  32. 32.
    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.CrossRefPubMedGoogle Scholar
  33. 33.
    Giulianotti PC, Sbrana F, Bianco FM, Addeo P. Robot-assisted laparoscopic extended right hepatectomy with biliary reconstruction. J Laparoendosc Adv Surg Tech A. 2010;20(2):159–63.CrossRefPubMedGoogle Scholar
  34. 34.
    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.CrossRefPubMedGoogle Scholar
  35. 35.
    Lai EC, Yang GP, Tang CN. Robot-assisted laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy - A comparative study. Int J Surg. 2012;10(9):475–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Tomulescu V, Stanciulea O, Balescu I, Vasile S, Tudor S, Gheorghe C, et al. First year experience of robotic-assisted laparoscopic surgery with 153 cases in a general surgery department: indications, technique and results. Chirurgia (Bucur). 2009;104(2): 141–50.Google Scholar
  37. 37.
    Wakabayashi G, Sasaki A, Nishizuka S, Furukawa T, Kitajima M. Our initial experience with robotic hepato-biliary-pancreatic surgery. J Hepatobiliary Pancreat Sci. 2011;18(4):481–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Choi SB, Park JS, Kim JK, Hyung WJ, Kim KS, Yoon DS, et al. Early experiences of robotic-assisted laparoscopic liver resection. Yonsei Med J. 2008;49(4):632–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Gill J, Booth MI, Stratford J, Dehn TC. The extended learning curve for laparoscopic fundoplication: a cohort analysis of 400 consecutive cases. J Gastrointest Surg. 2007;11(4):487–92.CrossRefPubMedGoogle Scholar
  40. 40.
    Hardacre JM. Is there a learning curve for pancreaticoduodenectomy after fellowship training? HPB Surg. 2010;2010:230287.CrossRefPubMedGoogle Scholar
  41. 41.
    Tekkis PP, Senagore AJ, Delaney CP, Fazio VW. Evaluation of the learning curve in laparoscopic colorectal surgery: comparison of right-sided and left-sided resections. Ann Surg. 2005;242(1):83–91.CrossRefPubMedGoogle Scholar
  42. 42.
    Tseng JF, Pisters PW, Lee JE, Wang H, Gomez HF, Sun CC, et al. The learning curve in pancreatic surgery. Surgery. 2007;141(5):694–701.CrossRefPubMedGoogle Scholar
  43. 43.
    An open-source robo-surgeon. The Economist. Technology Quarterly 2012 Mar 3; Q1.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • M. Shirin Sabbaghian
    • 1
  • David L. Bartlett
    • 1
  • Allan Tsung
    • 2
    Email author
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.Division of Hepatobiliary and Pancreatic SurgeryDepartment of Surgery, University of Pittsburgh Medical CenterPittsburghUSA

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