Laparoscopic and Robotic Liver Surgery

Minimally invasive surgery has become the standard approach to a variety of benign and malignant liver and biliary diseases. Technical advances and outcomes are comparable or even superior to the open approach and this has been responsible for its wide acceptance. Laparoscopic liver resection and robotic liver surgery are the last areas of resistance to the offensive of laparoscopic surgery. The reasons for the limited development in the past were the presumed technical problems, concerning intraoperative massive bleeding, gas embolism and inadequate oncological margins. However, technological refinements, such as staplers, probes, retractors, new platforms and technical standardization have overcome this issue and many centres have adopted laparoscopy liver resection as the standard approach for lesions located in the left lobe or superficial lesions in the right liver side. Despite the experience in hepatobiliary surgery and the long learning curve, many centers over the world have achieved very good outcomes and laparoscopy has been used even for living related liver donation for right lobe.

Robotic liver surgery has also evolved in the last few years and despite its high cost, it has been used mainly because technical limitations seen with the pure laparoscopic technique can be overcome with the use of robotic platforms. New technologies, such as augmented reality, image guided surgery and 3D ultrasound instruments, can be applied to robotic platforms and have the potential to guide complex resections.

The scope of this section is to publish cutting edge articles in the filed of laparoscopic and robotic liver surgery.