Four clamp-crush techniques in robotic hepatectomy (with video)

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robotic hepatectomy is increasingly reported, but specific techniques for parenchymal transection are evolving.
• Conventional methods like clamp-crush and Cavitron Ultrasonic Surgical Aspirator (CUSA) are common in laparoscopic hepatectomy, but robotic-compatible CUSA is unavailable.
• Standardizing clamp-crush techniques for robotic liver surgery is crucial for its widespread adoption.

Purpose of the Study:

• To describe and categorize four distinct clamp-crush techniques for robotic hepatectomy.
• To evaluate the outcomes, safety, and feasibility of these techniques in a clinical setting.
• To compare robotic hepatectomy outcomes with those of traditional laparoscopic hepatectomy.

Main Methods:

• Retrospective review of 58 patients undergoing robotic hepatectomy at Iwate Medical University Hospital (June 2022 - April 2024).
• Comparison with 298 patients who underwent pure laparoscopic hepatectomy (January 2014 - December 2020) at the same institution.
• Detailed description and video demonstration of four clamp-crush techniques: Clamp, Peck, Open, and Sweep.

Main Results:

• The study included 58 patients with various liver resections (limited, subsegmentectomy, sectionectomy, hemihepatectomy).
• Mean operative time was 205.9 minutes, with a mean blood loss of 103.1 mL; no conversions to laparotomy were required.
• Perioperative outcomes were comparable to laparoscopic hepatectomy, demonstrating no significant differences.

Conclusions:

• Robotic hepatectomy utilizing standardized clamp-crush techniques is safe and feasible in experienced high-volume centers.
• The established clamp-crush methods used in laparoscopic surgery can be effectively translated to robotic platforms.
• This facilitates a seamless transition for surgical teams moving from laparoscopic to robotic liver resections.