OPEN, LAPAROSCOPIC, AND ROBOTIC LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA: A NARRATIVE REVIEW OF CURRENT EVIDENCE
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6276Keywords:
Hepatocellular Carcinoma, Liver Resection, Robotic Surgery, Laparoscopic Surgery, Minimally Invasive Surgery, Narrative ReviewAbstract
Surgical resection remains the cornerstone of curative-intent treatment for appropriately selected patients with hepatocellular carcinoma (HCC). Over recent decades, advances in surgical technology have led to the development and widespread adoption of minimally invasive approaches, including laparoscopic liver resection (LLR) and robotic liver resection (RLR), offering alternatives to conventional open liver resection (OLR). This narrative review compares open, laparoscopic, and robotic liver resection techniques for HCC with regard to perioperative outcomes, oncological effectiveness, postoperative complications, economic considerations, and emerging clinical technologies. A comprehensive analysis of the current literature indicates that minimally invasive approaches are associated with reduced intraoperative blood loss, shorter hospital stays, faster postoperative recovery, and lower complication rates compared with open surgery. Robotic liver resection further enhances surgical precision, dexterity, and visualization, particularly in anatomically complex subdiaphragmatic procedures. However, concerns remain regarding higher procedural costs, longer operative times during the learning curve, and the limited availability of robotic systems. Current evidence suggests that oncological outcomes, including resection margin status, disease-free survival, and overall survival, are comparable among all three approaches when stringent patient selection criteria are applied. Laparoscopic and robotic liver resections represent safe and effective alternatives to conventional open surgery. Continued technological advancements, including artificial intelligence-assisted navigation, fluorescence-guided surgery, and next-generation robotic platforms, are expected to further strengthen the role of minimally invasive techniques in the management of HCC.
References
Badani, K. K., Hemal, A. K., & Kavoussi, L. R. (2008). 3D HD vision in robotic surgery. Journal of Endourology, 22(4), 615–618. https://doi.org/10.1089/end.2007.0343
Ban, D., Tanabe, M., Ito, H., Otsuka, Y., Nitta, H., Kaneko, H., ... & Wakabayashi, G. (2015). The difficulty of laparoscopic liver resection. Updates in Surgery, 67(2), 123–128. https://doi.org/10.1007/s13304-015-0294-x
Barbash, G. I., & Glied, S. A. (2010). New technology and health care costs—The case of robot-assisted surgery. New England Journal of Medicine, 363(8), 701–704. https://doi.org/10.1056/NEJMp1006602
Belghiti, J., Hiramatsu, K., & Wamur, S. (2000). Seven hundred forty-seven hepatectomies in the 1990s: An update to evaluate the actual risk of liver resection. Journal of the American College of Surgeons, 191(1), 38–46. https://doi.org/10.1016/S1072-7515(00)00261-1
Berguer, R., Rabindranath, K. S., & Abela, J. E. (1997). A comparison of surgeons' posture during laparoscopic and open surgical procedures. Surgical Endoscopy, 11(2), 139–142. https://doi.org/10.1007/s004649900311
Boggi, U., Amorese, G., & Vistoli, F. (2013). Learning curve and operative times in robotic surgery. Surgical Endoscopy, 27(1), 122–129. https://doi.org/10.1007/s00464-012-2415-y
Bone, R. C. (1991). The pathogenesis of sepsis. Annals of Internal Medicine, 115(6), 457–469. https://doi.org/10.7326/0003-4819-115-6-457
Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide. CA: A Cancer Journal for Clinicians, 68(6), 394–424. https://doi.org/10.3322/caac.21492
Cherqui, D., Husson, E., Hammoud, R., Malassagne, B., Stéphan, F., Bensaid, S., ... & Fagniez, P. L. (2000). Laparoscopic liver resections: A feasibility study in 30 patients. Annals of Surgery, 232(6), 753–762. https://doi.org/10.1097/00000658-200012000-00003
Ciria, R., Cherqui, D., Geller, D. A., Boni, L., Buell, J. F., Dagher, I., ... & Edwin, B. (2016). Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Annals of Surgery, 263(4), 761–777. https://doi.org/10.1097/SLA.0000000000001413
Clavien, P. A., Petrowsky, H., DeOliveira, M. L., & Graf, R. (2007). Strategies for safer liver surgery and partial liver transplantation. New England Journal of Medicine, 356(15), 1545–1559. https://doi.org/10.1056/NEJMra065156
Dalager, T., Sørensen, J. L., & Lauridsen, M. C. (2017). Musculoskeletal pain among surgeons performing minimally invasive surgery: A systematic review. Surgical Endoscopy, 31(2), 516–526. https://doi.org/10.1007/s00464-016-5017-z
Dindo, D., Demartines, N., & Clavien, P. A. (2004). Classification of surgical complications: A new proposal. Annals of Surgery, 240(2), 205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
EASL. (2018). Clinical practice guidelines: Management of hepatocellular carcinoma. Journal of Hepatology, 69(1), 182–236. https://doi.org/10.1016/j.jhep.2018.03.019
El-Serag, H. B. (2012). Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 142(6), 1264–1273. https://doi.org/10.1053/j.gastro.2011.12.061
Forner, A., Reig, M., & Bruix, J. (2018). Hepatocellular carcinoma. The Lancet, 391(10127), 1301–1314. https://doi.org/10.1016/S0140-6736(18)30010-2
Fretland, A. A., Dogen, J. H., & Bjørnbeth, B. A. (2018). Laparoscopic versus open resection for colorectal liver metastases. Annals of Surgery, 267(2), 199–207. https://doi.org/10.1097/SLA.0000000000002353
Giulianotti, P. C., Coratti, A., & Sbrana, F. (2011). Robotic liver surgery: Results for 70 resections. Surgery, 149(1), 29–39. https://doi.org/10.1016/j.surg.2010.04.004
Gurusamy, K. S., & Davidson, B. R. (2015). Outcomes of robotic vs laparoscopic hepatectomy: A systematic review and meta-analysis. World Journal of Gastroenterology, 21(34), 10059–10066. https://doi.org/10.3748/wjg.v21.i34.10059
Hammond, J. S., Guha, I. N., & Beckingham, I. J. (2022). Post-hepatectomy liver failure: A comprehensive overview. HPB, 24(12), 2065–2074. https://doi.org/10.1016/j.hpb.2022.06.009
Ishizawa, T., Tamura, S., & Masuda, K. (2009). Real-time identification of liver cancers by using indocyanine green fluorescent imaging. Cancer, 115(11), 2491–2504. https://doi.org/10.1002/cncr.24291
Jarnagin, W. R., Gonen, M., & Fong, Y. (2002). Improvement in perioperative outcome after hepatic resection. Annals of Surgery, 236(4), 397–406. https://doi.org/10.1097/00000658-200210000-00002
Johnson, P. J., Berhane, S., Kagebayashi, C., Satomura, S., Teng, M., Reeves, H. L., ... & D'Avola, D. (2015). Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach—the ALBI grade. Journal of Clinical Oncology, 33(6), 550–558. https://doi.org/10.1200/JCO.2014.57.9151
Lanfranco, A. R., Castellanos, A. E., Desai, J. P., & Meyers, W. C. (2004). Robotic surgery: A current perspective. Annals of Surgery, 239(1), 14–21. https://doi.org/10.1097/01.sla.0000103020.19595.7d
Liang, B., Peng, Y., & Chen, J. (2024). Robotic versus laparoscopic liver resection for posterosuperior segments: A systematic review and meta-analysis. HPB, 26(1), 45–54. https://doi.org/10.1016/j.hpb.2023.08.016
Llovet, J. M., Kelley, R. K., Villanueva, A., Singal, A. G., Pikarsky, E., Roayaie, S., ... & Kelley, R. K. (2021). Hepatocellular carcinoma. Nature Reviews Disease Primers, 7(1), 6. https://doi.org/10.1038/s41572-020-00240-3
Mazzaferro, V., Regalia, E., & Doci, R. (1996). Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. New England Journal of Medicine, 334(11), 693–699. https://doi.org/10.1056/NEJM199603143341104
McGlynn, K. A., Petrick, J. L., & El-Serag, H. B. (2021). Epidemiology of hepatocellular carcinoma. Hepatology, 73(Suppl. 1), 4–13. https://doi.org/10.1002/hep.31288
Nguyen, K. T., Laurent, A., & Dagher, I. (2010). Oncological outcomes of minimally invasive liver surgery. Journal of Surgical Oncology, 102(8), 1025–1029. https://doi.org/10.1002/jso.21639
Nota, C. L., Cuesta, M. A., & de Jong, K. P. (2016). The use of the hanging maneuver in minimally invasive liver surgery. Journal of Laparoendoscopic & Advanced Surgical Techniques, 26(1), 50–55. https://doi.org/10.1089/lap.2015.0298
Pellicciaro, M., Attanasio, A., & Boni, L. (2022). Artificial intelligence and intraoperative navigation in liver surgery. Updates in Surgery, 74(2), 395–403. https://doi.org/10.1007/s13304-022-01256-w
Pessaux, P., Diana, M., & Mutter, D. (2015). Towards cybernetic surgery: Robotic and augmented reality-assisted liver segmentectomy. Annals of Surgery, 261(1), 14–15. https://doi.org/10.1097/SLA.0000000000000781
Pringle, J. H. (1908). Notes on the arrest of hepatic hemorrhage due to trauma. Annals of Surgery, 48(4), 541–549. https://doi.org/10.1097/00000658-190810000-00005
Reddy, S. K., Tsung, A., & Geller, D. A. (2012). Underlying steatohepatitis, but not steatosis, increases morbidity after hepatic resection. Journal of the American College of Surgeons, 215(1), 87–95. https://doi.org/10.1016/j.jamcollsurg.2012.03.013
Safiejko, K., Krawczyk, M., & Zieniewicz, K. (2024). Robotic versus laparoscopic liver resections for colorectal metastases: A systematic review and meta-analysis. Cancers, 16(8), 1596. https://doi.org/10.3390/cancers16081596
Tohme, S., Simmons, R. L., & Tsung, A. (2017). Surgery for cancer: A trigger for metastases. Cancer Research, 77(7), 1548–1552. https://doi.org/10.1158/0008-5472.CAN-16-2531
Tsung, A., Geller, D. A., & Sukato, D. C. (2014). Robotic versus laparoscopic hepatectomy: A matched comparison. Annals of Surgery, 259(3), 549–555. https://doi.org/10.1097/SLA.0000000000000084
Turchetti, G., Palla, I., & Pierotti, F. (2012). Economic evaluation of da Vinci-assisted robotic surgery: A systematic review. Surgical Endoscopy, 26(3), 598–606. https://doi.org/10.1007/s00464-011-1925-z
Vercauteren, T., Unberath, M., & Padoy, N. (2020). Artificial intelligence in ultrasound-guided interventions. Medical Image Analysis, 65, 101784. https://doi.org/10.1016/j.media.2020.101784
Wakabayashi, G., Cherqui, D., & Geller, D. A. (2015). Recommendations for laparoscopic liver resection: A report from the second international consensus conference held in Morioka. Annals of Surgery, 261(4), 619–629. https://doi.org/10.1097/SLA.0000000000000840
Yang, J. D., Hainaut, P., & Gores, G. J. (2019). A global view of hepatocellular carcinoma: Trends, risk, prevention and management. Nature Reviews Gastroenterology & Hepatology, 16(10), 589–604. https://doi.org/10.1038/s41575-019-0186-y
Younossi, Z. M., Koenig, A. B., Abdelatif, D., Fazel, Y., Henry, L., & Wymer, M. (2016). Global epidemiology of nonalcoholic fatty liver disease. Hepatology, 64(1), 73–84. https://doi.org/10.1002/hep.28431
Ziogas, I. A., Rauf, A., & Giannis, D. (2021). Efficacy of robotic, laparoscopic, and open liver resection for hepatocellular carcinoma: A network meta-analysis. Journal of Robotic Surgery, 15(4), 533–544. https://doi.org/10.1007/s11701-020-01150-x
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Magdalena Kossmann, laura Szalewska, Paulina Osuch-Tomaszewska, Wiktoria Urowska, Izabela Kazubek-Fuksiewicz, Julia Burtowicz, Beniamin Piotr Rembowski, Magdalena Pitek, Agata Kaniewska
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
How to Cite
