Short-pitch dividing method for robotic liver resection: a conceptual shift to close-to-open separation from open-to-close crushing

Robotic liver resection (RLR) commonly relies on the clamp crushing method because a dedicated robotic ultrasonic aspirator is unavailable. However, crushing-type maneuvers inherently risk injury to small vascular and biliary structures, and this risk may be amplified in RLR due to the absence of tactile feedback. This study introduces a novel parenchymal transection strategy-the short-pitch dividing method combined with a double-hand transection method-with five auxiliary techniques designed to mitigate limitations of the robotic platform.

Consecutive patients undergoing RLR or laparoscopic liver resection (LLR) during 2019-2025 were reviewed. Perioperative outcomes were compared between groups.

The short-pitch dividing method involves inserting the closed tip of the Maryland bipolar forceps into the liver parenchyma and then slightly opening it. Repeating this "close-to-open" motion rapidly and continuously enables controlled and atraumatic parenchymal division and facilitates early identification of small Glissonean pedicles and hepatic veins. The proportion of intermediate/high-complexity resections was significantly higher in the RLR groups than in the LLR group: 45.8% vs. 31.9%, P = 0.043. No patient developed bile leakage in the RLR group, compared with 6 patients (3.1%) in the LLR group. Median postoperative hospital stay was significantly shorter in the RLR group than in the LLR group (4 days vs. 6 days, P < 0.001).

This study demonstrates a novel robotic parenchymal transection technique centered on the short-pitch dividing method, representing a conceptual shift from traditional "open-to-close" crushing techniques. This approach minimizes structural injury, and improves procedural efficiency, supporting its utility in RLR.