Totally Robotic Right Hepatectomy Surgical Technique and Outcomes

Hypothesis: Robotic surgery for performance of right hepatectomy is safe and effective. Design: Case series from 2 medical institutions. Setting: University of Illinois at Chicago and Misericordia Hospital, Grosseto, Italy. Patients: Twenty-four patients underwent right hepatectomy between March 1, 2005, and January 31, 2010, using a robotic surgical system. Main Outcome Measures: Intraoperative blood loss, operative time, morbidity, mortality, and long-term oncologic follow-up. Results: The procedure was converted to open surgery in 1 patient (4.2%). The overall mean (SD) operative time was 337 (65) minutes (range, 240-480 minutes), and the mean (SD) intraoperative blood loss was 457 (401) mL (range, 100-2000 mL). Three patients (12.5%) under-went blood transfusion. There were no perioperative deaths and no reoperations. Six patients (25.0%) experienced postoperative morbidity, including transitory liver failure in 2 patients and pleural effusion, bile leak, fluid collection, and deep venous thrombosis in 1 patient each. The patients' diagnoses included colorectal liver metastases (n=11), noncolorectal liver metastases (n=4), hemangioma (n=4), adenoma (n=2), hepatocellular carcinoma (n=1), hepatoblastoma (n=1), and biliary amartoma (n=1). At a mean follow-up duration of 34 months, no port site metastases were observed in patients with malignant pathologic findings. Conclusions: The zero mortality and acceptable morbidity of our series indicate that in experienced hands, robotic right hepatectomy is feasible and safe. Robotic surgery offers a new technical option for minimally invasive major hepatic resections. Long-term results seem to confirm oncologic effectiveness of the procedure.