Abstract Background Robotic surgery represents the most advanced evolution of minimally invasive liver surgery, progressively extending its application from minor resections to highly complex hepatobiliary procedures. Beyond the traditional definition of major hepatectomy, surgical complexity is increasingly determined by anatomical location, proximity to major vascular and biliary structures, patient-related factors, and integration within multimodal treatment strategies. Methods A narrative and critical review of the literature was conducted using PubMed/MEDLINE, focusing on robotic liver resections performed in technically complex settings. Case series, original studies, meta-analyses, consensus statements, and guidelines from high-volume centers with expertise in minimally invasive liver surgery were preferentially included. Results Current evidence supports the technical feasibility and safety of robotic liver surgery across multiple domains of complexity, including resections of posterosuperior segments, parenchyma-sparing procedures for centrally located tumors, vascular and biliary resections with reconstruction, and resections following liver volume augmentation strategies. Selected experiences also demonstrate feasibility in extreme scenarios such as robotic living donor hepatectomy and liver transplantation. Compared with open surgery, robotic approaches are associated with reduced surgical trauma and shorter hospital stay. Potential advantages over laparoscopy are mainly technical and procedure specific. Long-term oncological superiority has not been conclusively demonstrated in the current literature. Conclusions Robotic liver surgery has matured into a versatile platform capable of supporting highly complex hepatobiliary procedures in carefully selected patients. Its value lies in enhancing technical precision and facilitating minimally invasive procedures within established oncological and transplant indications. Widespread adoption should remain limited to specialized, high-volume centers with structured training and multidisciplinary expertise.
Mascherini et al. (Mon,) studied this question.