title: Robotic-assisted minimally invasive liver resection.
abstract: BACKGROUND
  Minimally invasive liver resection is feasible for select patients. The flexibility of robotic surgical instruments improves the possibility of minimally invasive liver resection, even in challenging major liver resection.
  
  
  METHODS
  We accumulated 69 patients who underwent pure laparoscopic liver resection from 2007 to 2011, and 52 patients who underwent robotic-assisted minimally invasive liver resection in 2012. The patients' characteristics, surgical procedures, and perioperative parameters were described and compared between these two groups.
  
  
  RESULTS
  In 2012, we performed 56 robotic hepatobiliary procedures, which included 52 (92%) robotic-assisted minimally invasive liver resection procedures. Under the assistance of a robotic system, we increased the number of patients undergoing minimally invasive liver resection by more than twofold, and we increased the percentage of minimally invasive surgery for patients with fresh hepatocellular carcinoma, compared to our laparoscopic group (44% vs. 15%, respectively). We also increased the percentage of major hepatectomy for minimally invasive liver resection by a robotic approach (39% vs. 15%) with a comparable conversion rate (5%) and morbidity (8%), compared to the laparoscopic group. We can even perform a challenging living donor liver harvest procedure with a robotic-assisted minimally invasive approach.
  
  
  CONCLUSIONS
  Robotic assistance increased the percentage of minimally invasive liver resections and the percentage of major minimally invasive liver resections with comparable perioperative results. Robotic-assisted minimally invasive liver resection is feasible, but its role needs more accumulated experience to clarify.
authors.affiliation: Department of Surgery, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan. Electronic address: wyaoming@gmail.com.
authors.forename: Yao-Ming
authors.initials: YM
authors.lastname: Wu
authors.affiliation: Department of Surgery, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: Rey-Heng
authors.initials: RH
authors.lastname: Hu
authors.affiliation: Department of Surgery, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: Hong-Shiee
authors.initials: HS
authors.lastname: Lai
authors.affiliation: Department of Surgery, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D065287:Robotic Surgical Procedures; D012371:Robotics
keywords: minimally invasive liver resection; robotic hepatectomy