Safety of robotic hepatic parenchymal transection using scissor hepatectomy and alternative techniques: a cohort...

Parenchymal transection represents a critical and challenging step in liver surgery. To date, there is no broadly accepted parenchymal transection technique in robotic liver surgery. This study aimed to compare the scissor hepatectomy technique to other parenchymal transection techniques.

A prospective database comprising 243 consecutive patients who underwent robotic hepatectomies at a single center was reviewed. The cohort was divided based on whether they received robotic parenchymal transection via scissor hepatectomy or alternative transection techniques. Propensity score matching and logistic regression analyses were carried out.

Between 2020 and 2024, a total of 207 patients met the eligibility criteria with a median age of 64 years (55-70). Of these, 117 (57%) patients underwent parenchymal transection by scissor hepatectomy, while alternative transection techniques (including Bipolar, SynchroSeal, VesselSealer, Hydrojet, and CUSA) were utilized in 90 (43%) patients. SH was associated with lower intraoperative blood loss in both unmatched and matched groups (71 patients in each group). Postoperative Grade III or higher morbidity was comparable between groups (13% vs. 14%, p < 0.99). No risk factors were identified as being associated with Grade III or higher postoperative morbidity.

Scissor hepatectomy is demonstrated to be a safe pure robotic parenchymal transection technique. Prospective randomized trials are warranted to compare this approach to other parenchymal transection techniques.