Related Experiment Video
Updated: Jul 3, 2026
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Feasibility and perioperative safety of robotic liver resection using the da Vinci SP system: early single-center
Takeshi Murakami1, Masafumi Imamura2, Koichi Okuya1
1Department of Surgery, Division of Gastroenterological Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-Ku, Sapporo, Hokkaido, 060-0061, Japan.
Background:
Clinical evidence for robotic liver resection (RLR) using the da Vinci SP™ system remains limited, particularly regarding perioperative outcomes during early implementation. We report an early single-center case series of RLR using the da Vinci SP system, primarily performed with a single-port (SP) -plus-one approach.
Methods:
This retrospective study included consecutive patients who underwent RLR using the da Vinci SP system at a single institution. Prespecified safety endpoints were conversion, intraoperative transfusion, major complications (Clavien-Dindo grade ≥ IIIa), bile leakage, posthepatectomy liver failure (PHLF), posthepatectomy hemorrhage (PHH), readmission, and 30-day mortality. Bile leakage, PHLF, and PHH were defined according to International Study Group of Liver Surgery criteria. Operative metrics, postoperative stay, and margin status were also assessed.
Results:
Between October 2024 and December 2025, 20 patients underwent RLR using the da Vinci SP system. Median age was 74 years (range, 25-87), tumor size was 1.9 cm (range, 0.8-11.0), and Iwate difficulty score was 5 (range, 2-11). An SP-plus-one approach was used in 17 cases, whereas a true SP approach was used in 3. Anatomical resection was performed in eight patients, including four hemihepatectomies. No conversions or intraoperative transfusions were required. One patient experienced a major complication (duodenal ulcer bleeding requiring endoscopic hemostasis). No bile leakage, PHLF, PHH, readmissions, or 30-day mortality occurred. Median operative time was 283 min (range, 123-575), estimated blood loss was 33 mL (range, 5-200), and postoperative stay was 7.5 days (range, 4-11). R0 resection was achieved in all malignant cases.
Conclusions:
In this early single-center case series, RLR using the da Vinci SP system was feasible in carefully selected patients, with no apparent increase in perioperative risk. These findings are descriptive and hypothesis-generating; larger multicenter prospective studies are warranted to define the clinical value and optimal role of the da Vinci SP in hepatobiliary surgery.
