Robotic Resection of the Liver Caudate Lobe: Technical Description and Initial Consideration

Abstract

BackgroundFirst described in 2002, the use of robotic liver surgery has not spread widely due to its high cost and the lack of a standardized training program. While still considered a technique ‘under development’, it has the potential to overcome the traditional limitations of the laparoscopic approach in liver surgery. MethodsWe analyzed the postoperative outcomes of 10 patients who had undergone robotic partial resection of the caudate lobe (Spiegel lobe) from March 2014 to May 2016 in order to evaluate the advantages of the robotic technique in the hands of a young surgeon. ResultsThe mean operative time was 258min (150–522) and the estimated blood loss 137ml (50–359); in none of the cases was blood transfusion required. No patients underwent conversion to open surgery; the overall morbidity was 2/10 (20%), and none of the complications (biliary fistula and pleural effusion) required surgical revision. At histological examination, the mean tumor size was 2.63cm, and we achieved an R0-resection rate of 100%. The 90-day mortality rate was null. The 1-year overall and disease-free survival rates were 100% and 80%, respectively. ConclusionsDespite several concerns regarding cost-effectiveness, fully robotic partial resection of the caudate lobe is an advantageous, implementable technique that provides promising short-term postoperative outcomes with an acceptable benefit–risk profile.