Is There a Place for Robotic Resection?

The ability to safely perform sound oncologic resections in an organ with the complex three-dimensional anatomy and dense vascularity of the liver was a major advance in minimally invasive surgery. Data on laparoscopic hepatectomy for colorectal liver metastases demonstrate good oncologic outcomes and improved perioperative outcomes compared to open hepatectomy. The robotic platform has several technological advantages over laparoscopy including wristed articulating instruments, a stable, high-definition three-dimensional camera controlled by the operating surgeon, a tremor filter, and built-in fluorescence imaging capability. These advances may facilitate a shorter learning curve and performance of more complex resections compared to laparoscopy including resection of tumors in the posterosuperior segments due to better visualization and ability to work in difficult-to-reach aspects of the liver. Limitations of robotic hepatectomy include increased cost and limited instruments for parenchymal dissection. More long-term data on cost, oncologic outcomes, patient-reported outcomes, and quality of life following robotic hepatectomy for colorectal liver metastases are needed.