Robotic Hepatectomy for Primary Liver Cancer

The incidence of and mortality rates for primary liver cancer, mainly hepatocellular carcinoma, have increased over time. Compared with open hepatectomy, minimally invasive hepatectomy is safe for patients, with lower blood loss, shorter length of stay, and less post-operative morbidity without compromising oncologic outcomes. A minimally invasive approach allows shorter post-operative recovery and start of adjuvant therapy sooner than with open hepatectomy. However, minimally invasive hepatectomy is likely an underutilized approach for surgical management because of the greater technical difficulty and learning curve than for open hepatectomy. Within the past decade, robotic hepatectomy has allowed integration of higher complexity cases than the laparoscopic approach, with integration of wrist dexterity, improved visualization, and tremor elimination. Robotic hepatectomy is associated with longer operative times than, but similar length of stay and complication rates to, laparoscopic hepatectomy. For patients with hepatocellular carcinoma, the disease-free and overall survival are at least similar, if not better, for those who undergo robotic versus laparoscopic hepatectomy. Robotic hepatectomy combines the case complexity of the open approach and the improved outcomes of the minimally invasive approach. This allows patients who are classed as high risk, due to cirrhosis or older age, access to surgical resection for liver cancer. Concerns about the surgical learning curve for robotic hepatectomy can be mitigated using a team-based surgery approach. Future technologic advances, validation of a difficulty scoring system, and continued tracking of long-term oncologic outcomes for robotic hepatectomy are a priority for the surgical community.