Mini-invasive treatment of hepatic hemangioma: new efforts for an uncommon task

The hepatic hemangioma (HH) represents an extremely common liver disease, however not requiring in the great majority of cases any kind of management. In peculiar cases, observation should be considered. Surgery is anecdotal, mainly in light of the evidence that spontaneous or post-traumatic rupture represent rare conditions. Surgery is indicated only in peculiar conditions, like the presence of abdominal pain otherwise not explicable, and the complications of HH. In this uncommon condition, the mini-invasive approach should play a relevant role, mainly in consideration of the fact that HH represents a benign condition. Consequently, a less invasive approach appears to be coherent in this field. Approximately 500 cases of laparoscopic surgery/locoregional therapy have been reported so far, showing promising results. Even more anecdotal are the reported cases of robotic resection. Only 10 cases of robotic surgery for HH have been reported. Therefore, it is impossible to give definitive conclusions on the role of robotic surgery in this field. When the mini-invasive approach is chosen as the first-step technique to use for the cure of a patient, surgery should be done exclusively in high-volume centers specialized in mini-invasive surgery.