A European expert consensus surgical technique description for robotic hepatectomy

The robotic platform enables surgeons to operate with a similar level of freedom and control as in open surgery, while still providing the patient with the benefits of a minimally invasive approach. More centres continue to adopt robotic liver surgery however standardized training materials and consensus on the surgical technique are currently lacking. The availability of a standardized surgical protocol could benefit the further dissemination of the robotic approach while promoting safe and effective operating techniques. We present a comprehensive surgical technique description for robotic hepatectomy agreed upon by seven expert robotic liver surgeons in Europe. They contributed insights from their extensive experience with the robot to develop this report, highlighting the key steps and important considerations for performing robotic hepatectomy. We describe the surgical technique for four most common hepatectomy types with varying complexity: partial anterolateral resections, partial posterosuperior resections, left hepatectomy and right hepatectomy. This report encompasses recommendations from the experts, covering the preparatory steps such as patient selection and pre-operative imaging, and extending through to care in the postoperative phase. The step-by-step surgical technique description serves as a compendium of best practice methods presently utilized in robotic liver surgery. Although some variations in technique cannot be eliminated from practice, general recommendations in a structured form will help to homogenize the technique, safeguarding surgical quality. This paper aims to inform and advise surgeons in the process of adopting robotic liver surgery and can act as a starting point for further optimization and refinement of the technique.