Robotic Hepatectomy: A New Paradigm in the Management of Hepatocellular Carcinoma?

Excerpt

We congratulate Chen et al. for reporting possible benefits of robotic hepatectomy for hepatocellular carcinoma (HCC).1 In the present report, these experienced surgeons demonstrate that, compared with open hepatectomy, robotic hepatectomy can provide superior short-term outcomes (shorter hospital stay and decreased need for patient-controlled analgesia) and similar long-term outcomes (recurrence-free survival [RFS] and overall survival) despite longer operative times. Per the authors, the prolonged operative times were associated with the time required to dock the robot, exchange instruments, and perform delicate dissection without haptic feedback. While it has already emerged that laparoscopic surgery performed by experienced liver surgeons results in better postoperative outcomes than open surgery for minor liver resections, the additive benefits for robotic hepatectomy due to the potential advantages of instrument flexibility, stability, and three-dimensional vision are less defined.2,3 A concern regarding the increased cost of the robotic approach over the laparoscopic approach emerges again in this study (robotic was almost twice as expensive) and warrants a more in-depth analysis as to the main contributors. …