Historical evolution and current state of robotic liver surgery

In the 1980s, ‘open’ liver resection was known to be associated with prohibitively high morbidity and mortality. Several reasons for the poor outcomes were complex vascular and biliary structures within the liver, difficulty in anatomical exposure, and tendency for major bleeding to occur during parenchymal transection. With advancement of surgical techniques, better instrumentation for hemostasis, and improved perioperative care, the feasibility and safety of liver resection improved significantly. Cure from hepatocellular carcinoma now became a reality for many patients, who were otherwise facing a death sentence (1,2).