Robot-assisted laparoscopic hemi-hepatectomy: Technique and surgical outcomes
Eric C.H. Lai*, Chung Ngai Tang, Michael K.W. Li
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Road, Chai Wan, Hong Kong SAR, China
a r t i c l e i n f o
Received 25 August 2011
Received in revised form
6 October 2011
Accepted 25 October 2011
Available online 3 November 2011
Laparoscopic liver resection
a b s t r a c t
Background: Laparoscopic major hepatectomies remain a challenge for liver surgeons. The recent
introduction of robotic surgical systems has revolutionized the field of minimally invasive surgery. It was
developed to overcome the disadvantages of conventional laparoscopic surgery. The use of robotic
system in laparoscopic major hepatectomy was not known yet.
Methods: Between December 2010 and July 2011, 6 right hemi-hepatectomies and 4 left hemi-
hepatectomies were performed by robot-assisted laparoscopic approach. Prospectively collected data
was analyzed retrospectively.
Results: Overall mean duration of the operation was 347.4 ? 85.9 (SD) minutes. Mean duration of the
operation for right hemi-hepatectomy was 364.8 ? 98.1 ml, while mean duration of the operation for left
hemi-hepatectomy was 321.3 ? 67.8 ml. Overall mean operative blood loss was 407 ? 286.8 ml. Mean
operative blood loss for right hemi-hepatectomy was 500 ? 303.3 ml, while mean operative blood loss
for left hemi-hepatectomy was 156.9 ? 40.7 ml. No open conversion was needed. Three patients (30%)
had postoperative complications. There was no mortality. Mean hospital stay was 6.7 ? 3.5 days.
Conclusions: Our series indicate that in experienced hands, robot-assisted laparoscopic approach for
hemi-hepatectomy is feasible and safe. As experience grows, this procedure will be more common.
? 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
The development of minimally invasive surgery over the last
two decades has had a great impact on surgical practice. Laparo-
scopic liver resection also becomes possible with the availability of
new instruments that allow a relatively bloodless liver transection.
The advantages of laparoscopic liver resection are those of mini-
mally invasive surgery, such as early recovery, shorter hospital stay,
and better cosmetic outcome.1e4The postoperative course after
laparoscopic liver resection has also become improved in patients
with cirrhosis because the abdominal wall is preserved, kinetics of
the diaphragm are improved, collateral venous drainage is better
and there is less postoperative ascites. Laparoscopy is generally
considered to be more suitable for minor hepatectomies in the
anterior and inferior segments.5An increasing number of laparo-
scopic major hepatectomy have only been reported by highly
specialized teams.6e8This is mainly because of concerns for tech-
nical difficulties of parenchymal transection, and difficulty in
controlling major hemorrhage via the laparoscopic approach.
Traditionally, laparoscopic liver resection can either be total
laparoscopic or hand-assisted laparoscopic approach. The recent
introduction of robotic surgical systems has revolutionized the field
of minimally invasive surgery. It was developed to overcome the
disadvantages of conventional laparoscopic surgery. The role of
robotic system in laparoscopic liver surgery has not been well
evaluated to date.9e11
The aim of the present cohort study was to study the clinical
outcome of robot-assisted laparoscopic hemi-hepatectomy.
2. Materials and methods
A prospective evaluation of robot-assisted laparoscopic liver resection was
initiatedin ourdepartment in 2009. Atthe end of 2010, westarted performing major
hepatectomy by robot-assisted laparoscopic surgery, including right and left hemi-
hepatectomies. The selection criteria for right and left hemi-hepatectomies were as
follows: tumor ? 6 cm in diameter, no major vascular invasion, non-cirrhotic liver or
Child-Pugh class A cirrhosis; and American Society of Anesthesiologists score
(ASA) ? 3. Patients were informed about the surgical procedure, and consent was
obtained before surgery. All procedures were performed by consultant surgeons
with expertise in hepatobiliary and laparoscopic surgery after obtaining informed
2.1. Patient positioning and port placement
The patient is placed in a supine positionwith legs apart. The patient is placed in
a 20?reverse Trendelenburg position. Five ports are generally used. They are
* Corresponding author. Tel.: þ86 852 2595 7123; fax: þ86 852 2515 3195.
E-mail address: email@example.com (E.C.H. Lai).
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International Journal of Surgery
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1743-9191/$ e see front matter ? 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
International Journal of Surgery 10 (2012) 11e15