A Decade of Innovation: Short-Term Outcomes of 150 Robotic Liver Resections

Background: Robotic liver resection (RLR) has seen remarkable advancements in recent years, overcoming many limitations of laparoscopic liver resection (LLR). RLR has evolved to include increasingly complex procedures, offering enhanced precision, reduced blood loss, and lower complication rates. Materials and Methods: A total of 150 consecutive RLRs, performed at the Department of General Surgery II and HPB Unit of Santa Chiara Hospital (Trento, Italy), between January 2013 and June 2024 were retrospectively reviewed. Collected data included demographics, disease etiology, operative parameters, oncologic margins, and perioperative outcomes. Results: Indications were malignant disease in 83% of cases while benign disease accounted for 17%. Minor resections accounted for 91%. Cirrhosis was present in 49% of patients (Child-Pugh A 91%; B 9%; mean MELD 9). According to the Iwate difficulty score, resections were low difficulty in 38% of cases, intermediate in 50%, advanced in 7%, expert in 5%. Conversion rate was 12%, mainly for bleeding or adhesions. Mean blood loss was 159 mL (66% <100 mL); Pringle maneuver was used in 3%; drains omitted in 45%; ICG fluorescence used in 81%. Mean operative time was 250 min (console time 184 min). Mean lesion size was 34 mm; R0 margin rate was 82%. Overall mortality was 1.3%; morbidity 24% (Clavien-Dindo ≥ III in 10%). Mean hospital stay was 7 days (median 5; range 2-46). Conclusions: RLR is a safe and effective alternative to laparoscopy, providing comparable or superior perioperative outcomes. Medium-volume centers can achieve high-quality results with RLR. Continued technological advancements will further expand its applications to increasingly complex liver procedures.