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Ruzzenente et al. Mini-invasive Surg 2020;4:91 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.90

Review Open Access

Robotic liver surgery: literature review and current
evidence

Andrea Ruzzenente, Laura Alaimo, Simone Conci, Fabio Bagante, Tommaso Campagnaro, Corrado
Pedrazzani, Alfredo Guglielmi

Department of Surgery, Unit of Hepato-Pancreato-Biliary Surgery, Verona 37134, Italy.
Correspondence to: Dr. Andrea Ruzzenente, Department of Surgery, Unit of Hepato-Pancreato-Biliary Surgery, G.B. Rossi
Hospital, University of Verona, Verona 37134, Italy. E-mail: andrea.ruzzenente@univr.it
How to cite this article: Ruzzenente A, Alaimo L, Conci S, Bagante F, Campagnaro T, Pedrazzani C, Guglielmi A. Robotic liver
surgery: literature review and current evidence. Mini-invasive Surg 2020;4:91. http://dx.doi.org/10.20517/2574-1225.2020.90
Received: 20 Sep 2020 First Decision: 28 Oct 2020 Revised: 27 Nov 2020 Accepted: 1 Dec 2020 Published: 19 Dec 2020

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

Abstract
In the field of minimally invasive surgery, robotic surgery (RS) was introduced to overcome drawbacks in
laparoscopic surgery. However, its clinical application in hepatobiliary surgery is not yet standardized. This review
analyzed the results of RS to clarify the benefits of robotic liver surgery in comparison with standard laparoscopy.
Among 112 publications found in the literature, the 72 most relevant were selected and the following data were
extracted: patients characteristics, operative procedures, histopathology, short-term and long-term outcomes, and
costs. Twenty-nine articles on robotic liver resections, published in the last five years (2015-2020) and including
1831 patients, were analyzed. Twenty-five comparative studies between robotic and laparoscopic surgery were
evaluated to underline the differences in operative outcomes. Eventually, 4 sub-group analyses were conducted on
hepatocellular carcinoma, gallbladder cancer, hilar cholangiocarcinoma, and colorectal liver metastases. Almost all
the authors reported data on safety, feasibility and oncologic effectiveness of RS reaching comparable results with
laparoscopy. However, even if robotic surgery showed longer operative time and higher costs, in selected cases it
allowed to increase the rate of minimally invasive approach when compared with laparoscopy. Thus, both open and
minimally invasive surgery should be provided in a modern hepatobiliary center, including the robotic approach
particularly to complex cases, otherwise very demanding by laparoscopy. In conclusion, different techniques
should be tailored to each patient, choosing the minimally invasive approach when possible, enhancing patients’
recovery after surgery, especially in cirrhotic livers and in the context of liver transplantation. Although many
centers experienced robotic liver surgery, more and larger studies are necessary to define its real benefits relative to
laparoscopy, in order to standardize patient selection criteria and techniques.

© 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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