Positioning of Minimally Invasive Liver Surgery for Hepatocellular Carcinoma: From Laparoscopic to Robot-Assisted Liver Resection

SIMPLE SUMMARY: Laparoscopic liver resection is widely accepted in the surgical treatment of hepatocellular carcinoma. Laparoscopic liver resection has been reported to result in earlier postoperative recovery and fewer postoperative complications than open liver resection for hepatocellular carcinoma. Laparoscopic liver resection is technically feasible for selected patients with hepatocellular carcinoma even under several situations such as the prevalence of liver cirrhosis, obesity, elderly, hepatocellular carcinoma recurrence (repeat liver resection), and major resection that led to better intra- and post-operative outcomes than open liver resection. In recent years, robot-assisted liver resection has gradually become popular, and its short- and long-term results for hepatocellular carcinoma are reported to be not different from those of laparoscopic liver resection. Robot-assisted liver resection is expected to become the mainstay of minimally invasive surgery in the future. ABSTRACT: Laparoscopic liver resection (LLR) is widely accepted in the surgical treatment of hepatocellular carcinoma (HCC) through international consensus conferences and the development of difficulty classifications. LLR has been reported to result in earlier postoperative recovery and fewer postoperative complications than open liver resection (OLR) for HCC. However, the prevalence of liver cirrhosis, obesity, the elderly, HCC recurrence (repeat liver resection), and major resection must be considered for LLR for HCC. Some systematic reviews, meta-analysis studies, and large cohort studies indicated that LLR is technically feasible for selected patients with HCC with these factors that led to less intraoperative blood loss, fewer transfusions and postoperative complication incidences, and shorter hospital stays than OLR. Furthermore, some reported LLR prevents postoperative loss of independence. No difference was reported in long-term outcomes among patients with HCC who underwent LLR and OLR; however, some recent reports indicated better long-term outcomes with LLR. In recent years, robot-assisted liver resection (RALR) has gradually become popular, and its short- and long-term results for HCC are not different from those of LLR. Additionally, RALR is expected to become the mainstay of minimally invasive surgery in the future.