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Lai et al. Hepatoma Res 2017;3:278-83                                Hepatoma Research
           DOI: 10.20517/2394-5079.2017.37
                                                                                                  www.hrjournal.net
            Topic: Management of Huge and Advanced Hepatocellular Carcinoma                     Open Access

           Robotic hepatectomy for hepatocellular

           carcinoma: a clinical review



           Eric C.H. Lai, Daniel T.M. Chung, Oliver C.Y. Chan, Chung Ngai Tang

           Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China.
           Correspondence to: Dr. Eric C.H. Lai, Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong,
           China. E-mail: elaichun@gmail.com
           How to cite this article: Lai ECH, Chung DTM, Chan OCY, Tang CN. Robotic hepatectomy for hepatocellular carcinoma: a clinical review. Hepatoma
           Res 2017;3:278-83.
                                         ABSTRACT

            Article history:              The robotic surgical system was developed to overcome the disadvantages of conventional
            Received: 21 Aug 2017         laparoscopic surgery. The use of robots in liver surgery was not well evaluated. This article aimed
            First Decision: 20 Sep 2017   at reviewing robotic partial hepatectomy to conventional laparoscopic or open partial hepatectomy
            Revised: 4 Oct 2017           in terms of perioperative, oncologic, and healthcare costs for hepatocellular carcinoma (HCC).
                                          Studies  were  identified  by  searching  MEDLINE  and  PubMed  databases  for  articles  from
            Accepted: 26 Oct 2017         January 2004 to June 2017 using the keywords "laparoscopic hepatectomy", "robotic surgery",
            Published: 27 Nov 2017
                                          "robotic hepatectomy", and "hepatocellular carcinoma". Case reports were not included. The
            Key words:                    open conversion rate, overall morbidity rate, and mortality rate of robotic partial hepatectomy
            Laparoscopy,                  were reported as 0-14.3%, 0-27%, and 0-3%, respectively. Although little data regarding robotic
            hepatectomy,                  approach for HCC have been reported, it appears to be better than open approach, particularly
            robotic surgery,              blood loss and hospital stay, and similar to conventional laparoscopic approach in terms of short
            hepatocellular carcinoma      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.


           INTRODUCTION                                       development is also lag behind other gastrointestinal
                                                              organs’ development. These advanced techniques
           The introduction of minimally invasive surgery (MIS)   also require highly experienced laparoscopic skills.
           has revolutionized surgical practice in the past 3   Increasing  understanding  of  liver  anatomy  and
           decades. MIS benefits patients in terms of better   advancements in technology have facilitated the
           pain control, shorter hospital stay, earlier recovery,   development of MIS approach of hepatectomy [1,2] .
           and better cosmesis [Table 1]. Traditionally, liver   Two international expert consensus conferences
           surgery is considered as one of the most challenging   on laparoscopic partial hepatectomy were held in
           surgeries among the abdominal procedures. Its MIS   Louisville, KY, USA, in 2008 and in Morioka, Japan,

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