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Ishizawa et al. Mini-invasive Surg 2021;5:52 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.81

Perspective Open Access

Minimally invasive liver resection in Japan: is the

robot necessary?

Takeaki Ishizawa, Kiyoshi Hasegawa
Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo,
Tokyo 113-8655, Japan

Correspondence to: Kiyoshi Hasegawa, MD, PhD, FACS, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery,
Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
E-mail: hasegawa-2su@h.u-tokyo.ac.jp
How to cite this article: Ishizawa T, Hasegawa K. Minimally invasive liver resection in Japan: is the robot necessary? Mini-
invasive Surg 2021;5:52. https://dx.doi.org/10.20517/2574-1225.2021.81
Received: 29 Jun 2021 First Decision: 20 Jul 2021 Revised: 17 Aug 2021 Accepted: 1 Sep 2021 Available online: 5 Nov 2021

Academic Editors: Andrew A. Gumbs, Kit Fai LEE Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Robot-assisted hepatectomy (RAH) is rarely indicated in Japan because of the lack of reimbursement from the
national health insurance system. Instead, laparoscopic hepatectomy has been approved for all hepatectomy
procedures except resections requiring biliary reconstruction. An obvious advantage of RAH over laparoscopic
hepatectomy is the fact that surgeons can use multi-articulated surgical devices, which may facilitate resection of
superior/posterior hepatic regions, hilar dissection, biliary reconstruction, and hepatic segmentation by
fluorescence imaging. With the accumulation of evidence supporting the use of robotic surgical devices in
particular situations of hepatectomy, RAH will become more commonly indicated in Japan under the existing
nationwide reporting system and board certification systems to assure surgical safety.

Keywords: Robot-assisted hepatectomy, laparoscopic hepatectomy, minimally invasive hepatectomy, anatomic
hepatectomy, fluorescence imaging

INTRODUCTION
During the past three decades, the indications for laparoscopic hepatectomy (LH) have been dramatically
extended based on technical, oncological, and regional factors. In Japan, LH for limited resections and left
lateral sectionectomy was first reimbursed by the national health insurance system in 2010; this was

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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