Totally robotic liver resection for hepatocellular carcinoma in cirrhotic patients: safety and feasibility

Although the application of robotic-assisted techniques is widespread in urology, gynecology, and in thoracic, general and cardiac surgery, few studies have assessed the feasibility and advantages of robotic-assisted surgery for liver tumors. In particular, no authors have assessed the benefits of the application of totally robotic LR (TR-LR) to the specific setting of HCC on liver cirrhosis. Between March and December 2011, 18 TR-LRs were performed at our institute. The operation was performed on account of a single nodule of HCC associated with liver cirrhosis in 10 (56 %) patients, who were included in the study. To expand the significance of study results, patients were compared to a series of ten selected totally laparoscopic LR (TL-LR) of HCC on liver cirrhosis (also performed at our institute) by case-matching analysis. Analysis of the peri-operative data disclosed significant differences in the median number of packed red blood cell units transfused (TR-LR 0.3 vs TL-LR 0.8: P value = 0.008) and of fresh frozen plasma units transfused (TR-LR 0.7 vs TL-LR 1.3: P value = 0.035). Oncological features in the two groups were similar. In our experience, at present TR-LR appears to be the major minimally invasive technique that has the best chance of reproducing the results achieved with open liver surgery. TR-LR significantly reduces the risk of bleeding and transfusion. Furthermore, and probably more importantly, the risk of non-radical tumor resection appears to be lower for TR-LR than TL-LR.