Major Robotic Liver Hepatectomy: Is It a Good Option? Experience from a Single Surgical Center

Introduction, Materials and Methods: We present our experience on consecutive patients undergoing robotic major hepatectomy (resection of ≥3 liver segments) with a review of literature and a video on robotic right hepatectomy. Data were collected prospectively and analyzed retrospectively. Results: Robotic major hepatectomy was performed in 26 patients. There were 6 left hepatectomies, 16 right hepatectomies, 2 extended right hepatectomies, 1 fully robotic ALPSS (1st step), 1 en-bloc resection of segments VI, VII and VIII. The mean operating time was 420 min (240–725 min). Overall conversion rate and postoperative complication rate were 3.8% and 26.9%, respectively. The mean length of hospital stay was 10.5 days (6– 22 days). Conclusion: Our experience confirms the feasibility of all commonly performed major hepatic resections under robotic assistance. While the possible advantages of robotic assistance (vs. laparoscopy) cannot be derived from this yet limited experience, especially in the absence of a comparison arm, several considerations can instead be made. First, this series reflects the initial experience of a group with preemptive experience in advanced laparoscopy but without specific experience with laparoscopic major hepatectomy. As such, this series includes our learning curve but still shows satisfactory results. Second, robotic assistance allowed us to master all the procedures without taking any technical compromise with respect to our open approach. Third, and final, although impossible to show in fig- ures the enhanced dexterity offered by robotic assistance allowed all procedures to be completed with ease and with the feeling of a yet large margin of safety during each surgical step.