Sealer and Moisture-Based Approach (SAMBA) Hepatectomy Technique for Robotic Parenchymal Transection

Area of Science:

• Minimally Invasive Surgery
• Surgical Robotics
• Hepatobiliary Surgery

Background:

• Robotic sealing devices enable parenchymal transection without laparoscopic instruments.
• Existing techniques require more procedural guidance for consistent application.
• Need for standardized robotic hepatectomy procedures.

Purpose of the Study:

• To describe the Sealer and Moisture-Based Approach (SAMBA) hepatectomy technique.
• To present a standardized, purely robotic approach for hepatic parenchymal transection.
• To evaluate the efficacy of SAMBA hepatectomy.

Main Methods:

• The SAMBA technique combines robotic vessel-sealing tools with targeted saline irrigation.
• A total of 72 consecutive robotic hepatectomies were performed using SAMBA.
• Procedures were conducted at Ulm University Hospital between February 2021 and October 2024.

Main Results:

• The Da Vinci Xi-system was utilized for all procedures.
• Parenchymal transection used SynchroSeal (55 cases) or Vessel Sealer Extend (17 cases).
• Median operative time was 174 minutes with 200 mL blood loss; no posthepatectomy hemorrhage or mortality within 90 days.

Conclusions:

• SAMBA hepatectomy is an effective robotic liver parenchymal transection method.
• Incorporating moisture during sealing improves tissue handling, reduces carbonization, and enhances visualization.
• Further prospective studies are needed to compare SAMBA with other transection techniques.