Advancing Robotic Liver Resection: The Sling Technique for Improved Hepatic Retraction

Area of Science:

• Minimally Invasive Surgery
• Hepatobiliary Surgery
• Surgical Technology

Background:

• Hepatic surgery difficulty is assessed by lesion location (posterior segments), size, and liver disease.
• Tumors in segment 7 pose significant exposure challenges in liver resections.
• Traditional liver retractors can cause trauma and limit assistant maneuverability.

Purpose of the Study:

• To introduce and evaluate the "sling" technique for hepatic retraction in robotic surgery.
• To demonstrate an atraumatic and easily manipulable retraction method.
• To enhance visualization and access for difficult liver resections.

Main Methods:

• Utilized a "sling" technique with rolled surgical sponges for liver retraction.
• Placed the sling behind the liver, applying gentle retraction for mobilization.
• Demonstrated the technique through surgical videos in robotic liver surgery.

Main Results:

• The sling technique provided atraumatic and effective hepatic retraction.
• Improved exposure of difficult-to-access liver segments, including segment 7.
• Freed the assistant's arm and aligned the transection plane with the camera for enhanced visualization.

Conclusions:

• The sling technique is a cost-efficient, reproducible, and effective method for robotic liver surgery.
• It overcomes limitations of traditional retractors, offering superior exposure with minimal trauma.
• The technique facilitates safer and more efficient minimally invasive hepatic resections.