Minimally Invasive Liver Surgery for Hepatic Colorectal Metastases

Abstract

Minimally invasive surgery has been cautiously introduced in surgical oncology over the last two decades due to a concern of compromised oncological outcomes. Recently, it has been adopted in liver surgery for colorectal metastases. Colorectal cancer is a major cause of cancer-related death in the USA. In addition, liver metastasis is the most common site of distant disease and its resection improves survival. While open resection was the standard of care, laparoscopic liver surgery has become the standard of care for minor liver resections. Laparoscopic liver surgery provides equivalent oncological outcomes with better perioperative results compared to open liver surgery. Robotic liver surgery has been introduced as it is believed to overcome some of the limitations of laparoscopy. Finally, laparoscopic radio-frequency ablation and microwave coagulation can be used as adjuncts in minimally invasive surgery to complement or replace surgical resection when not possible.

Keywords: Colorectal cancer; Colorectal cancer liver metastasis; Laparoscopic liver surgery; Laparoscopic microwave ablation; Laparoscopic radio-frequency ablation; Minimally invasive liver surgery; Robotic liver surgery.

Fig. 1

a Trocar placement for robotic left lateral sectionectomy (red (R1–3), 8-mm trocars for robotic arms; purple (C) 12 mm for camera, and green (A1–2) 5- and 12-mm assistant ports). MCL is the midclavicular line, SUL the spinoumbilical line. b OR setup for robotic left lateral sectionectomy. c Robotic intraoperative ultrasound of the liver defining tumor extension and vascular/biliary anatomy. d Transection of the liver parenchyma with a robotic vessel sealer. e Dissection and transection of major vascular pedicles with an endoscopic vascular stapler. f Final hemostasis of the transected liver surface. A specimen is extracted in an endoscopic bag through an extended utility port (not shown)

Fig. 1

a Trocar placement for robotic left lateral sectionectomy (red (R1–3), 8-mm trocars for robotic arms; purple (C) 12 mm for camera, and green (A1–2) 5- and 12-mm assistant ports). MCL is the midclavicular line, SUL the spinoumbilical line. b OR setup for robotic left lateral sectionectomy. c Robotic intraoperative ultrasound of the liver defining tumor extension and vascular/biliary anatomy. d Transection of the liver parenchyma with a robotic vessel sealer. e Dissection and transection of major vascular pedicles with an endoscopic vascular stapler. f Final hemostasis of the transected liver surface. A specimen is extracted in an endoscopic bag through an extended utility port (not shown)