First US Program for Robotic Liver Surgery in Children
By Lindsay Gandolfo
Pediatric liver surgery is among the most complex and delicate procedures in modern medicine—and a new chapter is unfolding that combines thoughtful surgical expertise with groundbreaking robotic technology. As the first program in the United States performing robotic liver surgery in children, Columbia’s Robotic Liver Surgery Program is redefining the pediatric surgical landscape.
Robotic surgery is an advanced version of laparoscopy, providing 10x magnification and 3D depth perception, which is critical for delicate dissection and suturing. “We still use small laparoscopic incisions, but the robotic arms and enhanced camera allow us to perform complex operations with a minimally invasive approach that’s as safe and precise as open surgery,” says Jason Hawksworth, MD, chief of hepatobiliary surgery and director of the Robotic Liver Surgery Program.
Columbia started using robotic techniques for pediatric patients in the summer of 2023, beginning with small tumors localized on both sides of the liver, as well as bile duct surgery. The team is now moving to major liver resections for larger tumors, even malignant tumors.
“Also, patient selection expanded,” says pediatric transplant hepatologist Mercedes Martinez, MD. “We began with children over 15 kilos, and then 10 kilos, and now babies less than five kilos.” The youngest patient so far has been a 2-month-old, she adds.
Whether a tumor is benign or malignant is a decision branch point for choosing a minimally invasive approach. Malignant tumors involving vasculature still require open surgery. “If there’s a blood vessel that needs to be reconstructed, that’s very difficult to do minimally invasively,” says Dr. Hawksworth. But those cases are the exception. “For the vast majority, we can offer the robotic approach.”
Benefits for Patients and Families
When a family is referred to Columbia, they often first see Dr. Martinez and her team, who explain the diagnosis and introduce the idea of surgery, which is always overwhelming. “We begin laying the foundation: This will be minimally invasive, the scar will be small, the recovery will be shorter,” says Dr. Martinez. Tumors are extracted through a small incision below the waistline. “Our outcomes are excellent—even better than when we did open surgery in some cases. That helps families feel informed and empowered to move forward.”
Looking Ahead
In data presented at a recent international meeting in Korea, the team reported no difference in complications or cancer outcomes compared with open surgery. “But we did see shorter hospital stays, significantly lower narcotic use, and less postoperative pain,” says Dr. Hawksworth.
While broader adoption of the robotic approach seems likely, it will take time due to the rare combination of expertise—pediatric, transplant, and robotic surgery—it requires. “Very few teams have this combination of skills and resources,” says Dr. Hawksworth. “Like everything we do, we’ll move slowly and safely, methodically.”
For more information, contact 212-305-0914 or visit columbiasurgery.org/liver/roboticliver- surgery-program-columbia.