Robotic Resections in the Anterolateral Segments

Minimally invasive liver surgery has gained popularity in recent decades and has been accepted as an alternative to open surgery for selected liver resections due to its short-term benefits, particularly for minor hepatectomy [1–3]. Widespread adoption of minimally invasive liver surgery has been hampered by high technical difficulty due to limited exposure, instrument motion and a steep learning curve. Although the learning curve for laparoscopic liver resection was reported to be in the range of 45–75 procedures by pioneering surgeons [4], more recent studies by second-generation laparoscopic liver surgeons have suggested that the learning curve has reduced to around 20–25 procedures [5, 6]. There is emerging data that the robotic platform may facilitate complex procedures, potentially shortening the learning curve for minimally invasive liver resection, particularly for accessing difficult segments or for major hepatectomy [7–11]. The anterolateral liver segments (segments 2, 3, 4b, 5 and 6) are generally considered readily amenable to a minimally invasive approach. In this chapter we provide a comprehensive overview of the technical aspects and outcomes of robotic resection of the anterolateral segments.