Continuous Robotic Ultrasound Hepatectomy (CRUSH): A Novel Approach for Parenchyma-Sparing Liver Surgery

Parenchyma-sparing hepatectomy aims to achieve negative resection margins while preserving maximal functional liver tissue.^1,2 Intraoperative ultrasound is fundamental for spatial orientation but is typically used intermittently, leaving blind dissection intervals.³ PATIENTS AND METHODS: We herein present the Continuous Robotic UltraSound Hepatectomy (CRUSH) technique, which integrates continuous intraoperative ultrasound tracking by steady positioning of the ultrasound probe using robotic forceps. Three cases were performed using this novel robotic hepatectomy approach: (1) non-anatomic segment 4a resection (repeat hepatectomy)⁴ of a recurrent neuroendocrine metastasis, (2) non-anatomic segment 3 resection of a melanoma liver metastasis, and (3) non-anatomic segment 2 resection of a colorectal liver metastasis.

All procedures were successfully completed using the CRUSH technique without intraoperative or postoperative complications. The Da Vinci Xi-system was employed in all cases. Parenchymal transection was performed with monopolar scissors and bipolar forceps in two cases⁵, and with the SynchoSeal device in combination with bipolar forceps in one case. Negative resection margins were achieved in all three patients. Continuous ultrasound feedback provided uninterrupted visualization of the resection margin facilitating precise and controlled parenchyma-sparing transection.

The CRUSH technique is a safe and feasible parenchyma-sparing hepatectomy approach in robotic liver surgery. Future studies are warranted to evaluate its impact on margin status.