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Laparoscopic Anatomical Liver Segment VII Resection with Liver Parenchymal Transection Following a Priority Approach
Published on: May 23, 2025
Global Survey of Technical Preferences for Robotic Versus Laparoscopic Segmentectomy of Liver Segments 7 and 8: A
Keiichi Akahoshi1, Taiga Wakabayashi2, Hitoe Nishino3
1Department of Hepatobiliary and Pancreatic Surgery, Institute of Science Tokyo, Tokyo, Japan.
Background:
Segmentectomy of liver segments 7 and 8 (S7/8) is technically challenging due to their posterosuperior location and proximity to major hepatic veins. With the increasing adoption of robotic surgery, current practices for S7/8 resection across different surgical modalities remain unclear.
Methods:
An international web-based survey was conducted in 2024 among expert hepatobiliary surgeons. The 18-item questionnaire addressed institutional policies, technical preferences, and procedural strategies for laparoscopic and robotic S7/8 segmentectomy.
Results:
A total of 67 surgeons from 11 countries responded. Among them, 51% had performed over 20 laparoscopic S7/8 resections, whereas 57% had no experience with the robotic approach. Robotic S7/8 segmentectomy accounted for fewer than 20% of cases at most institutions. The Glissonean approach from the hilum and the Maryland bipolar dissector were more frequently used in robotic procedures. The cranio-dorsal approach to the right hepatic vein was less common in robotic surgery, while the cranio-ventral approach to the middle hepatic vein was common to both modalities.
Conclusions:
Robotic S7/8 segmentectomy remains in the early stages of adoption despite ergonomic and technical advantages. This international survey highlights distinct technical differences between laparoscopic and robotic approaches, emphasizing the need for targeted training and standardized device integration.
