Robotic Anatomical Liver Resection for Segment 7 Lesions Utilizing Saline-Linked Cautery (SLiC) Method

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Anatomical hepatectomy for segment 7 (S7) lesions presents significant technical challenges due to limited access and proximity to the right hepatic vein.
• The efficacy and safety of robotic approaches for S7 hepatectomy are not well-established.

Purpose of the Study:

• To present a novel technique for robotic anatomical hepatectomy for S7 lesions using the saline-linked cautery (SLiC) method.
• To compare surgical outcomes of robotic S7 hepatectomy with a historical laparoscopic control group.

Main Methods:

• A prospective study of 10 robotic S7 subsectionectomies or right posterior sectionectomies using the SLiC method (2022-2023).
• Comparison with a historical control group of 9 laparoscopic anatomical hepatectomies for S7 lesions (2017-2021).
• Outcomes assessed included operative time, blood loss, difficulty score, and postoperative complications.

Main Results:

• No conversions to open surgery, no grade B/C post-hepatectomy liver failure, and no mortality in the entire cohort.
• The robotic group showed significantly less surgical blood loss (28mL vs. 280mL, p=0.005) compared to the laparoscopic group.
• No significant differences were observed in operative time, difficulty score, or red blood cell transfusion rates.

Conclusions:

• Robotic anatomical hepatectomy for S7 lesions, utilizing the intrahepatic Glissonean approach with the SLiC method, is safe and feasible.
• This technique can be performed without increasing the incidence of postoperative complications.
• The robotic approach is a viable option for challenging S7 liver resections.