Safety and Feasibility of Robotic Liver Parenchymal Transection Using the Saline-Linked Cautery Method: A Propensity...

Despite its advantages over open and laparoscopic approaches, robotic liver parenchymal transection is difficult because of the lack of a standardized method. Saline-linked cautery (SLiC) method during robotic liver parenchymal transection was previously reported. To verify the safety and practicality of the SLiC method, the perioperative outcomes of laparoscopic liver resection (LLR) and robotic liver resection (RLR) were compared using propensity score matching (PSM).

LLRs and RLRs at our institution were analyzed from 2017 to 2024. Liver parenchymal transection of LLRs was performed using laparoscopic coagulating shears or cavitron ultrasonic surgical aspirator, and that of RLRs was performed using the SLiC method. Patient characteristics, surgical factors, and tumor factors were adjusted using PSM. Perioperative outcomes were compared between the LLR and RLR groups.

LLR was performed in 145 patients and RLR in 129. Before PSM, tumor size was significantly larger in LLRs than in RLRs, whereas the rate of repeat hepatectomy was significantly higher. Blood loss was significantly lower in RLRs. After PSM, 94 cases were matched and analyzed. RLR substantially reduced intraoperative blood loss (63 mL in LLR vs. 15 mL in RLR, p < 0.01). Multivariate analysis for a higher amount of blood loss showed that the RLR was an independent risk-reducing factor.

Comparable perioperative outcomes were observed between RLRs and LLRs, indicating that RLR can be performed safely and practically. The SLiC method is one of the preferred techniques for safer RLR with less blood loss.