Single port robotic hepatectomy: an initial European experience

Single port (SP) robotic surgery is the latest innovation in robotic surgery. Published evidence is limited and few series are available for SP robotic hepatectomy. The aim of this study was to investigate early feasibility of SP robotic hepatectomy in Europe.

Between February and June 2025, data on true SP and SP plus one robotic hepatectomies were systematically collected at three participating centres. The study focussed on the description of the cohort, feasibility, surgical outcome in terms of blood loss, postoperative complications according to Clavien-Dindo (C-D), specific posthepatectomy complications according to the International Study Group of Liver Surgery (ISGLS) definitions and length of hospital stay (LOS).

A total of 12 SP and SP plus one robotic hepatectomies were performed. The cohort comprises six females and six males with a median age of 62 (23.38-78.46) years and a body mass index of 25.9 (21.1-36.3) kg/m². The series included seven non-anatomical/subsegment hepatectomies, two left lateral sectionectomies, two right hepatectomies and one segmentectomy. The median length of incision was 3.5 (2.7-4.7) cm plus a Pfannenstiel incision for larger specimen retrieval in two cases. An additional port (10 mm) was used in six cases. No procedure was converted to open, the median blood loss was 100 (0-580) ml. The median LOS was 3.5 days (1-8). According to the C-D classification, complications were categorized as follows: two grade I, two grade II and one grade IIIa complication. None of these met the criteria for ISGLS posthepatectomy complications. Follow-up at 30 days was uneventful in all cases.

SP robotic hepatectomy is feasible when performed by experienced hepatobiliary surgeons. Larger series are needed to clearly define safety and the role of SP robotic hepatectomy within the armamentarium of hepatobiliary surgery and support the concept of tailored robotic-assisted surgery (T-RAS).