Robotic liver surgery—advantages and limitations

Robotic surgery is now within the standard of care for many operations, including hepatectomy. Robotic liver surgery has advantages over laparoscopic and open surgical techniques, but these must be weighed against certain limitations when selecting an approach.

Advantages and limitations of robotic liver surgery are discussed here based on a literature survey.

Advantages include improved surgeon ergonomics, better access to posterior and superior liver segments, excellent visualization, and ease of using indocyanine green. There may also be a shorter learning curve for use, and there are possibilities for technological assistance with surgery in the future. Limitations are related to those known for minimally invasive surgery in general, but also include time for docking and cost. Considerations are reviewed in detail to facilitate decision making when considering a robotic approach for liver surgery.

The robotic platform is not appropriate for all liver operations at this time. Benefits of robotic surgery are most clearly realized when approaching lesions in the posterior and superior segments, and when a large incision would be required to remove a small amount of liver parenchyma were the operation to be performed in an open fashion.