Totally robotic caudate lobe liver resection: Bridge over troubled water

Background Minimally invasive hepatectomy has well-known advantages over the traditional open approach. Inherent limitations of laparoscopy make major hepatectomies and the resection of upper and posterior segments a great technical challenge. The robotic approach overcomes most of these limitations, and this technology is most useful in the resection of the deeply located caudate lobe. Methods We describe the robotic caudate lobe resection technical aspects, using the first robotic resection of the caudate lobe to treat a biphenotypic hepatocholangiocarcinoma to illustrate the procedure. We also performed a literature review on the current status of the robotic approach to segment (Sg) 1. Results Technical approach to the robotic caudate lobe resection is described in a patient with uneventful post-operative recovery. Literature review demonstrated only four previous authors reporting the use of this technique. Conclusion We present a step-by-step approach to the hepatic Sg 1 resection by robotic approach.