Tips and tricks for the robotic-assisted approach to colorectal cancer liver metastases

Abstract

Colorectal cancer remains a leading cause of cancer-related morbidity and mortality, with liver metastases being a critical determinant of survival. The management of colorectal liver metastases (CRLM) has historically been challenging due to the complexity of hepatic resections and the need for precision to ensure patient safety and optimal outcomes. Recently, robotic hepatectomy has emerged as a pivotal evolution in minimally invasive surgery, offering a new tool in the treatment of CRLM. This article aims to share some tips and tricks accumulated by our surgical experience in robotic resections of CRLM that have been instrumental in optimizing both outcomes and safety. We explore the multifaceted approach required for successful robotic surgery. A meticulous preoperative evaluation sets the stage for successful robotic liver surgery, where we tailor anesthesia and patient positioning based on tumor location to complement the robotic platform. During surgery, the selection of specialized instruments along with nuanced parenchymal transection techniques is guided by a number of factors, including the quality of the liver and experience of the surgeon. Incremental progression from less to more complex hepatectomies is made possible by adherence to key principles of minimally invasive liver surgery, thoughtful preparation, and surgical precision. Ultimately, this article will contribute to surgeons’ understanding of these principles and practical elements that can help to improve standards of patient care in the performance of robotic hepatectomies for colorectal metastases.

Keywords

Liver cancer / robotic surgery / colorectal metastases / minimally invasive

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