The diffusion of the use of robotic surgical platforms, such as the da Vinci Xi Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA), has been advocated by several authors to overcome the limitations of laparoscopy in hepatobiliary surgery.

We reported our experience of robot-assisted fenestration of giant hepatic cysts in posterosuperior segments with the use of indocyanine green fluorescence imaging. We described step by step our surgical technique including the operative room set-up, port placement and robotic instruments.

We enrolled 11 patients: nine females and two males with a mean age of 65 years (range 52–80 yrs). All procedures were undertaken successfully without intraoperative or postoperative complications. The mean surgical operating time was 125 min. The mean blood loss was 30 ml. The median postoperative stay was two days (range, 1 to 3 days).

The most significant advantage of the robotic approach was the ability to access hepatic cysts close to the diaphragm.