Laparoscopic Resection of Liver Tumors Located in the Postero- Superior Segments: Is Robotic Assistance an Additional Value?

Introduction, Materials and Methods: We present our experience with robotic resection of 24 tumors located in postero-superior liver segments (i.e.,. IVa; VII; VIII) (P-SLS) along with a video on segment VIII resection and a review of the literature. Data were collected prospectively and analyzed retrospectively. Results: Surgery required a mean of 252 min (115–430) and was completed laparoscopi- cally in all but one patient (4.2%). Mean estimated blood loss was 150 ml (100–350). Post- operative complications occurred in 5 patients (20.8%). Median length of hospital stay was 12.7 days (5–96). All patients had a margin negative resection. Mean follow-up period of 21.4 months (±24.4). Conclusion: Our initial experience confirms that laparoscopic robot-assisted resection of tumors located in P-SLS is feasible and safe. Although it is known that tumors in the P-SLS can be resected by conventional laparoscopic techniques, it may be interesting to note that our experience reflects the prospective application of robotics to “all comers” with resectable tumors located in these segments and results refer to an “intention-to-treat” policy. Despite the lack of specific selection criteria, other than general suitability for laparoscopy, we were able to resect all tumors with negative margins and reasonable morbidity. If these results were duplicated on a larger scale, robotics could become a valid alternative to standard laparoscopy as it could allow more surgeons to resect tumors located in the P-SLS laparoscopically and/or remove some of the current anatomic selection criteria imposed by the intrinsic technical limitations of laparoscopy.