Liver parenchyma dissection in Totally robotic liver surgery - Results of the first 100 patients using the Robotic Harmonic curved shears-

Aim: Robotic liver surgery (RLS) is a feasible and safe procedure. However, limitations of the robotic instruments used for liver parenchyma dissection compared to laparoscopic and open approaches are major drawbacks of RLS. There is no established technique for liver parenchymal dissection in RLS. The aim of this study is to discuss the surgical outcomes of Totally RLS using Robotic Harmonic curve shears at the University Hospital of Copenhagen, Denmark. Methods: Between June 2019 and June 2022, RLS was performed with 100 patients. Patient variables and short-term outcomes were retrospectively analysed. Results: The mean patient age was 63.1 years; the median operating time was 246 min; and the median estimated blood loss was 100 mL. Thirty-two patients underwent subsegmentectomy, 18 mono-segmentectomies, 25 bi-segmentectomies, and 25 major hepatectomies. One patient (1.0%) required conversion to open surgery. Five patients experienced postoperative major complications (Clavien-Dindo classification ≥ IIIa) while no mortalities occurred. Median length of hospital stay was 3 days. There were no significant differences between minor and major hepatectomies in any of the factors. Conclusion: Based on our study of minor and major hepatectomies in Totally RLS, we conclude that the use of the Robotic Harmonic curve shear for liver parenchyma dissection is feasible and safe.