Surgeon-controlled robotic CUSA technique for liver parenchymal transection

Area of Science:

• Minimally invasive surgery
• Surgical technology
• Hepatobiliary surgery

Background:

• Robotic liver resection offers improved visualization but often requires bedside assistance for parenchymal transection, limiting surgeon control.
• A novel surgeon-controlled robotic CUSA (cavitational ultrasonic surgical aspirator) technique was developed using a simple attachment.
• This technique aims to increase console surgeon autonomy during robotic liver resections.

Purpose of the Study:

• To describe the surgeon-controlled robotic CUSA technique for liver resection.
• To evaluate the perioperative outcomes of this technique compared to the conventional clamp-crush method.
• To assess the feasibility and safety of enhanced surgeon control in robotic parenchymal transection.

Main Methods:

• Retrospective review of 44 patients undergoing robotic liver resection (October 2022 - December 2025).
• Comparison between the clamp-crush technique (early period) and the surgeon-controlled robotic CUSA technique (later period).
• Procedures performed by expert hepatobiliary surgeons using da Vinci Xi or hinotori robotic systems; outcomes analyzed statistically.

Main Results:

• No significant differences in perioperative outcomes (operation time, blood loss, complications, hospital stay, R0 resection) between the clamp-crush (19 patients) and robotic CUSA (25 patients) groups.
• Major or segmental resections were more frequent in the robotic CUSA group, though not statistically significant.
• No conversions to open or laparoscopic surgery were reported in either group.

Conclusions:

• The surgeon-controlled robotic CUSA technique achieves comparable perioperative outcomes to the clamp-crush method.
• This technique allows for surgeon-controlled parenchymal transection, enhancing autonomy in robotic liver surgery.
• It presents a valuable option for selected robotic liver resections in experienced centers.