Robotic vs. laparoscopic resection for hepatocellular carcinoma

Minimally invasive liver surgery (MILS) has become increasingly popular over the last two decades, with hepatocellular carcinoma (HCC) representing a common indication. While data has shown the benefits of a laparoscopic vs. an open approach, robotic liver surgery is rapidly emerging. In this context, among the two minimal access approaches [robotic (RLR) vs. laparoscopic liver resection (LLR)], a differential benefit is still under investigation. While the advantages of RLR include increased dexterity, reduction of physiological tremors, and wrist articulation, it currently has no haptic feedback or specialized liver parenchymal transection devices and is associated with increased operative time and cost. However, RLR has proved to be a safe and effective approach for select patients with HCC. Some benefits of RLR include similar oncological outcomes to open or laparoscopic surgery, possibly reduced conversion rates, and an easier transition from open surgery to a minimally invasive approach. Moreover, while already today RLR can facilitate resection for HCC in hard-to-reach anatomic locations (e.g., transthoracic approach to posterior-superior liver), the future of robotics with the development of advanced image processing technologies, haptic feedback, liver-specific devices, lower cost, and more robot choices seems even more promising.