What is Robotic Liver Surgery?

Robotic liver surgery is one type of minimally invasive surgery whereby a surgeon uses robotic assistance during surgery to remove liver tumours or diseased liver tissues by making small cuts. Robotic liver surgery gives more precision, increased visualization, lower blood loss, minimal pain, and quicker recovery as opposed to open surgery. The robotic arms replicate the surgeon's hand movements with exceptional precision while providing a magnified 3D view and greater instrument flexibility. This allows accurate tumour removal, better preservation of healthy liver tissue, and improved access to difficult-to-reach areas of the liver. 

A comparative study in the European Journal of Surgical Oncology found that robot-assisted liver surgery reduces major complication rates by nearly half, to 23.1%, compared to 41.9% for open surgery. The robotic approach also lowers median blood loss to 200 mL and shortens average hospital stays to 9.0 days, maintaining equivalent oncological resection quality while improving perioperative recovery.

Types of Robotic Liver Surgery

Depending on the location and extent of the liver disease, robotic liver surgery may include:

• Robotic Wedge Resection: Removal of a small portion of the liver containing a tumour or abnormal tissue.
• Robotic Segmentectomy: Removal of one or more liver segments while preserving the remaining healthy liver.
• Robotic Left or Right Hepatectomy: Removal of the left or right lobe of the liver for larger or multiple lesions.
• Extended Hepatectomy: Removal of a larger portion of the liver when required for complex tumours.
• Robotic Living Donor Hepatectomy: Removal of a portion of the liver from a healthy donor for liver transplantation in carefully selected cases.

Modern robotic platforms can also incorporate near-infrared fluorescence imaging (ICG), helping surgeons clearly identify blood vessels, bile ducts, and tumour boundaries during surgery.      

The robotic liver surgery process involves preoperative evaluation, general anaesthesia, small incisions, robotic-assisted liver resection, closure of incisions, and postoperative recovery. Most patients experience less pain and a quicker recovery than with open surgery. All the steps have been discussed below in brief:

Step 1: Preoperative Assessment

Your surgeon evaluates imaging scans, blood tests, liver function, and overall health to determine whether robotic surgery is appropriate.

Step 2: General Anaesthesia

The procedure is performed under general anaesthesia.

Step 3: Small Incisions

Several keyhole-sized incisions are made to insert robotic instruments and a high-definition 3D camera.

Step 4: Robotic Liver Resection

The surgeon controls the robotic system to precisely remove the diseased portion of the liver while preserving healthy tissue and surrounding structures.

Step 5: Closure

The removed tissue is extracted, bleeding is checked, and the incisions are closed.

Step 6: Recovery

Patients are monitored closely, encouraged to mobilise early, and typically recover faster with less postoperative discomfort than after open surgery.

Are There Any Risks?

Yes, robotic liver surgery carries some risks. However, these risks are generally low when the procedure is performed by an experienced hepatobiliary surgeon.

Potential risks of robotic liver surgery include:

• Bleeding
• Bile leakage
• Infection
• Blood clots
• Injury to nearby organs or blood vessels
• Anaesthesia-related complications
• Rare conversion to open surgery if required for patient safety

The overall risk varies depending on the patient's liver health, the complexity of the procedure, and underlying medical conditions. Your surgeon will carefully evaluate these factors and discuss the potential risks and benefits before recommending surgery.

Robotic liver surgery is used to treat selected liver cancers, benign liver tumours, liver cysts, and certain bile duct disorders. Suitability depends on the type, size, and location of the condition, as well as the patient's overall liver function.

Robotic liver surgery may be recommended for:

• Hepatocellular carcinoma (primary liver cancer)
• Liver metastases (secondary liver cancer)
• Intrahepatic cholangiocarcinoma
• Benign liver tumours (haemangioma, focal nodular hyperplasia, liver adenoma)
• Liver cysts
• Selected bile duct disorders
• Living donor liver surgery