Robot-assisted laparoscopic liver resection: First dutch experience

Abstract

Introduction: Robot-assisted laparoscopy has been introduced to overcome the limitations of conventional laparoscopy. This technique has potential advantages over laparoscopy, such as increased dexterity, 3-dimensional view and a magnified view of the operative field. Therefore, the improved dexterity may make a robotic system particularly suited for liver resections that require non-linear manipulation, such as curved parenchymal transection, hilar dissection and resection of the posterosuperior segments. Methods: Between August 2014 and August 2015, 11 patients underwent robot-assisted laparoscopic liver resection at University Medical Center Utrecht for malignant and benign hepatic lesions. Results: Ten robot-assisted laparoscopic liver resections were performed in a minimally invase manner. One of the procedures was converted. Four patients underwent a resection of an anterior segment (2, 3, 4B, 5, 6). Six patients underwent a resection of a posterosuperior segment (7, 8). Seven patients had previous abdominal surgery. Two patients underwent a laparoscopic bowel resection simultaneously. Median operating time was 184 (60–265) minutes and median blood loss was 225 (5–600) mL. Six patients had a complication, from which 2 patients suffered from a grade III complication (Clavien–Dindo). Median length of stay was 5 (4–8) days. There was no mortality. Conclusion: This prospective study reporting on our initial experience with robot-assisted laparoscopic liver resection demonstrates that this technique is easily adopted, safe and feasible for minor hepatectomies in selected patients. Moreover, it suggests that the robotic platform also enables fully laparoscopic resections of the posterior segments.