Robotic hepatectomy for hepatocellular carcinoma: a clinical review

Abstract

The robotic surgical system was developed to overcome the disadvantages of conventional laparoscopic surgery. The use of robots in liver surgery was not well evaluated. This article aimed at reviewing robotic partial hepatectomy to conventional laparoscopic or open partial hepatectomy in terms of perioperative, oncologic, and healthcare costs for hepatocellular carcinoma (HCC). Studies were identified by searching MEDLINE and PubMed databases for articles from January 2004 to June 2017 using the keywords "laparoscopic hepatectomy", "robotic surgery", "robotic hepatectomy", and "hepatocellular carcinoma". Case reports were not included. The open conversion rate, overall morbidity rate, and mortality rate of robotic partial hepatectomy were reported as 0-14.3%, 0-27%, and 0-3%, respectively. Although little data regarding robotic approach for HCC have been reported, it appears to be better than open approach, particularly blood loss and hospital stay, and similar to conventional laparoscopic approach in terms of short term outcomes. The oncological outcomes were comparable to open or laparoscopic approach. Well-known advantages of the robotic system allow resection of tumor location over posterior and superior segments or major hepatectomy with more ease. The main disadvantage of robotic approach was its high cost. In conclusion, oncological data from homogenous series of HCC after robotic partial hepatectomy was needed. Robotic approach was safe to be an alternative option of minimally invasive hepatectomy for HCC. Its future implementation will depend on the advantages that it can provide over open or conventional laparoscopy approach.

Keywords

Laparoscopy / hepatectomy / robotic surgery / hepatocellular carcinoma

References

[1] Lai EC,Yang GP.Multimodality laparoscopic liver resection for hepatic malignancy--from conventional total laparoscopic approach to robot-assisted laparoscopic approach..Int J Surg2011;9:324-8

[2] Lai EC,Li MK.Conventional laparoscopic and robot-assisted laparoscopic liver resection for benign and malignant pathologies: a cohort study..J Robot Surg2012;6:295-300

[3] Buell JF,Geller DA,Iannitti D,Koffron AJ,Gayet B,Wakabayashi G,Kaneko H,Scatton O,Abdalla EK,Dutson E,D'Angelica M,Testa G,Manas D,Nelson H,Clary B,Martinie J,Goldstein R,Barlet D,Abecassis M,Fong Y,Broelsch C,Belghiti J,Chari RS.The international position on laparoscopic liver surgery: The Louisville Statement, 2008..Ann Surg2009;250:825-30

[4] Wakabayashi G,Geller DA,Kaneko H,Asbun H,Tanabe M,Tsung A,Machado MA,Troisi RI,Van Dam RM,Abu Hilal M,Kwon CH,Choi GH,Cai X,Chen KH,Sugioka A,Herman P,Chen XP,Jarnagin W,Strong R,Lo CM,Kokudo N,Strasberg SM.Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka..Ann Surg2015;261:619-29

[5] Ciria R,Geller DA,Wakabayashi G.comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing..Ann Surg2016;263:761-77

[6] Lai EC.The continuing challenge of hepatic cancer in Asia..Surgeon2005;3:210-5

[7] Lau WY.Hepatocellular carcinoma: current management and recent advances..Hepatobiliary Pancreat Dis Int2008;7:237-57

[8] Lau WY.The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review..Ann Surg2009;249:20-5

[9] Lai EC,Yang GP.Minimally invasive surgical treatment of hepatocellular carcinoma: long-term outcome..World J Surg2009;33:2150-4

[10] Lai EC,Ha JP.Laparoscopic liver resection for hepatocellular carcinoma: ten-year experience in a single center..Arch Surg2009;144:143-7

[11] Lai EC.Radiofrequency ablation versus hepatic resection for hepatocellular carcinoma within the Milan criteria--a comparative study..Int J Surg2013;11:77-80

[12] Zhou YM,Zhao YF,Li B.Meta-analysis of laparoscopic versus open resection for hepatocellular carcinoma..Dig Dis Sci2011;56:1937-43

[13] Yin Z,Ye H,Wang J.Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma: a global systematic review and meta-analysis..Ann Surg Oncol2013;20:1203-15

[14] Twaij A,Sodergren MH,Darzi A.Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis: systematic review and meta-analysis..World J Gastroenterol2014;20:8274-81 PMCID:PMC4081703

[15] Patriti A,Ratti F,Ceccarelli G,Aldrighetti L.Robot-assisted versus open liver resection in the right posterior section..JSLS2014;18:e2014.00040

[16] Kingham TP,Kuk D,D'Angelica MI,DeMatteo RP,Jarnagin WR.Robotic liver resection: a case-matched comparison..World J Surg2016;40:1422-8 PMCID:PMC4870111

[17] Daskalaki D,Brown M,Tzvetanov I,Kim J,Giulianotti PC.Financial impact of the robotic approach in liver surgery: a comparative study of clinical outcomes and costs between the robotic and open technique in a single institution..J Laparoendosc Adv Surg Tech A2017;27:375-82 PMCID:PMC5397272

[18] Berber E,Aucejo F,Chalikonda S.Robotic versus laparoscopic resection of liver tumours..HPB (Oxford).2010;12:583-6 PMCID:PMC2997665

[19] Packiam V,Tohme S,Marsh JW,Tsung A.Minimally invasive liver resection: robotic versus laparoscopic left lateral sectionectomy..J Gastrointest Surg2012;16:2233-8 PMCID:PMC3509231

[20] Lai EC,Tang CN.Robot-assisted laparoscopic liver resection for hepatocellular carcinoma: short-term outcome..Am J Surg2013;205:697-702

[21] Tranchart H,Ferretti S,Patriti A.Traditional versus robot-assisted full laparoscopic liver resection: a matched-pair comparative study..World J Surg2014;38:2904-9

[22] Yu YD,Jung DH,Yoon SY,Lee SK.Robotic versus laparoscopic liver resection: a comparative study from a single center..Langenbecks Arch Surg2014;399:1039-45

[23] Kim JK,Han DH,Kim KS,Yoon DS.Robotic versus laparoscopic left lateral sectionectomy of liver..Surg Endosc2016;30:4756-64

[24] Montalti R,Patriti A,Troisi RI.Robotic versus laparoscopic resections of posterosuperior segments of the liver: a propensity score-matched comparison..Surg Endosc2016;30:1004-13

[25] Salloum C,Lahat E,Levesque E,Azoulay D.Robotic-assisted versus laparoscopic left lateral sectionectomy: analysis of surgical outcomes and costs by a propensity score matched cohort study..World J Surg2017;41:516-24

[26] Tsung A,Sukato DC,Tohme S,Marsh W,Bartlett DL.Robotic versus laparoscopic hepatectomy: a matched comparison..Ann Surg2014;259:549-55

[27] Spampinato MG,Bianco L,Laurenzi A,Ettorre GM.Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study..Surg Endosc2014;28:2973-9

[28] Wu YM,Lai HS.Robotic-assisted minimally invasive liver resection..Asian J Surg2014;37:53-7

[29] Lee KF,Chong CC,Fong AK.Laparoscopic and robotic hepatectomy: experience from a single centre..ANZ J Surg2016;86:122-6

[30] Lai EC.Robot-assisted laparoscopic partial caudate lobe resection for hepatocellular carcinoma in cirrhotic liver..Surg Laparosc Endosc Percutan Tech2014;24:e88-91

[31] Lai EC,Li MK.Robot-assisted laparoscopic hemi-hepatectomy: technique and surgical outcomes..Int J Surg2012;10:11-5

[32] Casciola L,Ceccarelli G,Ceribelli C.Robot-assisted parenchymal-sparing liver surgery including lesions located in the posterosuperior segments..Surg Endosc2011;25:3815-24

[33] Chen PD,Hu RH,Lai HS,Lee PH.robotic versus open hepatectomy for hepatocellular carcinoma: a matched comparison..Ann Surg Oncol2017;24:1021-8

[34] Lai EC.Long-term survival analysis of robotic versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: a comparative study..Surg Laparosc Endosc Percutan Tech2016;26:162-6

[35] Magistri P,Guidetti C,Olivieri T,Coratti A.Laparoscopic versus robotic surgery for hepatocellular carcinoma: the first 46 consecutive cases..J Surg Res2017;217:92-9