Robotic-assisted placement of hepatic arterial infusion pump

Introduction

Hepatic arterial infusion was described nearly six decades ago as a regional treatment of hepatic tumors (see Chapters 50 , 90 , and 97 ). Robotic-assisted approaches to placement of hepatic arterial infusion pumps have become more prevalent following the rise of minimally invasive hepatobiliary techniques over the past 20 years. The robotic-assisted approach to HAIP placement is associated with lower intraoperative blood loss compared with an open approach, and lower rate of conversion to open HAIP placement without a significant difference in operative time compared with a laparoscopic approach. Sequential improvements in robotic surgery platforms have allowed for increasingly complex procedures involving minimally invasive liver resections and concomitant placement of hepatic arterial infusion pumps for patients with appropriate indications, most commonly for adjuvant or induction therapy in colorectal liver metastasis, though expanding uses for HAIP therapy and combinations with systemic therapies are the subject of several active trials. Robotic-assisted HAIP placement has a short learning curve for surgeons with robotic hepatobiliary experience, and it can easily be combined with minimally invasive colorectal resection.