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Ziogas et al. Mini-invasive Surg 2020;4:69 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.63

Review Open Access

. laparoscopic major hepatectomy
Robotic vs

Ioannis A. Ziogas , Samer Tohme , David A. Geller 2
1
2
1 Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center,
Nashville, TN 37232, USA.
2 Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University of Pittsburgh Medical Center, Pittsburgh,
PA 15260, USA.
Correspondence to: Prof. David A. Geller, Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, University
of Pittsburgh Medical Center, Montefiore 7 South, 3459 Fifth Avenue, Pittsburgh, PA 15260, USA. E-mail: gellerda@upmc.edu
How to cite this article: Ziogas IA, Tohme S, Geller DA. Robotic vs. laparoscopic major hepatectomy. Mini-invasive Surg
2020;4:69. http://dx.doi.org/10.20517/2574-1225.2020.63
Received: 19 Jun 2020 First Decision: 31 Aug 2020 Revised: 31 Aug 2020 Accepted: 3 Sep 2020 Published: 12 Oct 2020

Academic Editor: Giulio Belli Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
The introduction of laparoscopic technology and surgical robots in hepatobiliary surgery in the 1990s and
2000s, respectively, has dramatically revolutionized the field. Even though laparoscopic and robotic major
hepatectomy was slower to adopt compared to minimally-invasive minor hepatectomy, the number of major
hepatectomies performed with both approaches worldwide has significantly increased and is still rising. Despite
the few comparative studies between laparoscopic and robotic major hepatectomy, most studies are focused
on describing the procedures or reporting the outcomes of each method, either separately, or mixed with minor
hepatectomies. Based on the available data, the direct comparison between the two techniques has shown that
when robotic major hepatectomy is performed by experienced hepatobiliary surgeons in high-volume centers,
it can lead to similar operating times, estimated blood loss, hospital length of stay, complication and mortality
rates compared to its laparoscopic counterpart. The likelihood of achieving a margin-negative resection in cancer
patients, as well as long-term disease-free and overall-survival are comparable between the groups. However,
broader adoption of the robotic approach might be a hurdle in low-volume centers due to the high fixed capital and
annual maintenance cost of the surgical robot.

Keywords: Hepatectomy, liver resection, major hepatectomy, laparoscopic, robotic, minimally-invasive

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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