Robot-assisted laparoscopic hepatectomy for hepatocellular carcinoma: The henri-mondor experience

Introduction: Laparoscopic hepatectomy remains technically challenging especially on cirrhosis. The recent introduction of robotic surgical systems has revolutionized the field of minimally invasive surgery in many different surgical specialties. Methods: Between July 2011 and November 2014, we performed 15 robotic hepatic resections for hepatocellular carcinoma (left lateral sectionectomy n = 5, atypical resection segment 2 n = 2, atypical resection segment 3 n = 3, atypical resection segment 4 n = 1, atypical resection segment 5 n = 1, atypical resection segment 6 n = 3). Cirrhosis was present in 14 patients and one patient had a normal liver parenchyma. No Pringle maneuver was used. Prospectively collected data was analyzed retrospectively. Results: Overall mean operative time was 170.1±70.5 minutes (range: 60-290). Overall mean intraoperative blood loss was 208±240 ml (range: 20–900). Two open conversions (13.3%) were needed due to bleeding. One patient (6.6%) had postoperative complications (biliary fistula treated conservatively). There was no mortality and no reoperations. Mean hospital stay was 5.6±2 days (range: 3–10). All patients had R0 resection with a mean margin of 13.3±16mm (range: 1– 65 mm). Four patients had resection as a bridge to liver transplantation and were transplanted safely with minimal adhesions at the time of transplantation. Conclusion: Robot-assisted laparoscopic hepatectomy for hepatocellular carcinoma is feasible and safe. Further evaluation with clinical trials is required to assess for improvement in outcomes and to validate its real benefits. Long-term oncologic outcomes are still pending.