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Page 10 of 15 Ruzzenente et al. Mini-invasive Surg 2020;4:91 I http://dx.doi.org/10.20517/2574-1225.2020.90

Table 4. Robotic surgery for gallbladder cancer
Authors Cases Age EBL Time Conversion Lymph nodes Extension R0 LoS Overall/major
complications
Goel et al. [19] 27 54 200 295 14.8 10/- pT2-3 100 4 3.7/3.7
Zeng et al. [48] 3 - 316* 370* 0 6.3/- pT2-3 - 3 -
Byun et al. [51] 16 64.3 295 198.3* - 7.2/3 - 100 7 6.3/6.3
Shen et al. [52] 5 57.4 210* 200* 0 9/1,3 - - 7.4* 0

Cases: number of patients. Major/minor resections: number of major/minor, according to the description of the authors or calculated
from the data supplied. EBL: milliliters (median/*mean). Operative time: minutes (median/*mean). Conversion rate: percentage
of procedures converted to open surgery. Lymph nodes: mean number of nodes obtained/mean number of positive nodes. R0:
percentage of negative margin status. LoS: days (median/*mean). Overall/major complications: percentage of all complications/major
complications. “-”: not reported

Table 5. Robotic surgery for hilar cholangiocarcinoma
Pre-op. Type of Operative Overall/major
Authors Cases Age procedures resection EBL time Conversion R0 LoS complications Biliary leak
Li et al. [17] 48 62.4 PTBD 41.7 RH/LH + Sg1 150 276 - 72.9 9 58.3/10.4 4.2
Xu et al. [53] 10 54 PVE 10, LH/RH + Sg1 (9) 1360 703 0 - 16 90/30 40
PTBD 60 ERH (1)
Cases: number of patients. PTBD: percentage of percutaneous trans-hepatic biliary drainage; PVE: percentage of portal vein
embolization; RH/LH: right/left hepatectomy; ERH: number of extended right hepatectomies; EBL: milliliters (median/*mean).
Operative time: minutes (median/*mean). Conversion rate: percentage of procedures converted to open surgery. R0: percentage of
negative margin status. LoS: days (median/*mean). Overall/major complications: percentage of all complications/major complications.
Biliary leak: percentage. “-“: not reported

allowing lymphadenectomy of groups 7, 8, 9, 12 and 13. However, they did not report details about the
extension of hepatectomies for each tumor stage and the rates of conversion to open surgery. Conversely,
[53]
Xu et al. evaluated their results for 10 patients of fully robotic-assisted radical resection for hCCC. The
authors demonstrated that this procedure is technically achievable in selected patients by expert surgeons,
but without superior results to open surgery. In fact, they observed technical limitations in robotic liver
mobilization and exposure, longer operative time and massive EBL, consequently increased morbidity,
higher costs and poor long-term outcomes with greater rate of peritoneum implantation and multisite
metastases.

Colorectal liver metastases
Many hepatobiliary surgeons encouraged the robotic approach to CRLM, achieving good surgical and
oncological outcomes. Seven articles were reviewed, including 242 patients [Table 6]. Beard et al.
[26]
focused their PSM on RS for CRLM and considered it feasible and safe, being perioperative and long-term
oncologic outcomes largely comparable to laparoscopy.

[54]
[43]
Araujo et al. and Troisi et al. demonstrated feasibility of non-anatomical robotic resections of
lesions located in postero-superior segments, simplifying parenchymal sparing resections, not affecting
the oncologic outcomes, reducing the necessity of major hepatectomies and overcoming laparoscopic
drawbacks.

Fifty-four simultaneous resections of the primary tumor and liver metastases were included. In these cases,
RS added additional safety and effectiveness in the management of multiple metastases, improving short-
term outcomes such as EBL, bowel function return time and LOS, with the exception of operative time,
reaching excellent R0 resection rates [34,55] . Even in selected cases requiring major liver resections, robotic
[56]
surgery gained acceptable morbidity . In addition, it is worth considering that robotic total mesorectal
excision demonstrated better preservation of urinary and sexual functions, low conversion rates and
[49]
favorable morbidity .