Robotic Surgery for Liver Cancer

Robotic Hepatic Lobectomy, Liver Wedge Resection, and Segmentectomy

Surgery commonly is a central part of the treatment algorithm for patients with primary or metastatic liver cancer. Primary liver cancer (hepatocellular carcinoma or cholangiocarcinoma) is the sixth most common cancer worldwide.  Metastatic colorectal cancer to the liver is now commonly treated with the combination of surgery and systemic chemotherapy. Since the liver is tucked away in the right upper quadrant of the abdomen, open surgery for this condition requires a very large abdominal incision both under the ribs and extending to the midline. Furthermore, even with a large incision, exposure is challenging. Many liver tumors can now be treated very effectively with minimally invasive surgical approaches, including robotic surgery, avoiding the need for a large incision and often facilitating removal of the tumor.

How Robotic Surgery for Liver Cancer is Performed

The liver is divided into two lobes and further subdivided into eight segments. The basic principle of liver surgery is to remove the tumor with negative margins while preserving enough remaining liver—as well as blood flow in and out of the liver—to maintain liver function. The type of robotic procedure performed to treat liver cancer depends on the location of the tumor and the biology of the disease process. For tumors in the periphery of the liver, either a single segmentectomy (surgical removal of one of the liver’s eight segments) or wedge resection (removal of the tumor along with some surrounding liver tissue) is often adequate. For larger tumors or more centrally located lesions, a formal right or left hepatic lobectomy (removal of one of the liver’s two lobes) may be required. The liver is unique in that after removing the diseased portion, the remaining good portion will hypertrophy (regrow) to help restore normal function of the liver. This regrowth can happen in as little as 2 to 3 weeks, and it is one of the reasons we can aggressively remove even large portions of the liver.

Minimally invasive approaches to these operations have been greatly facilitated by the addition of the da Vinci Si robot. As a result, many of these procedures which in the past routinely required a large incision can now be done with a few small incisions (less than one inch, on average).

Advantages of Robotic Surgery for Liver Cancer

The primary advantage of using the da Vinci Si robot for the surgical treatment of liver cancer, in addition to smaller scars and potentially quicker recovery times, is the enhanced intra-operative visualization. This can facilitate surgical precision, leading to less blood loss and improved outcomes overall.

Robotic Surgery for Liver Cancer at NYULMC

The GI/hepatobiliary surgical oncologists at NYU Langone Medical Center are among the first in the New York area to use the da Vinci robot for these applications, and are developing a comprehensive minimally-invasive and robotic program to treat all gastrointestinal (GI) cancers.

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