Novel single-port robotic hepatectomy: initial clinical experience and outcomes.

Abstract

Background: The objective of this study was to evaluate the feasibility, safety, and early outcomes of single-port (SP) robotic liver resection, including major and minor hepatectomies, using the da Vinci SP system in a low-to-intermediate-volume hepatobiliary center.

Methods: Twenty patients underwent robotic SP surgery between April 2024 and May 2025. Among them, 14 underwent liver resections using the SP platform, including five major (right or left hepatectomy) and nine minor (wedge resection, monosegmentectomy, caudate lobectomy, or left lateral sectionectomy) procedures. Perioperative and short-term outcomes were retrospectively analyzed. Surgical techniques, including port placement and inflow control, were standardized. In selected cases, indocyanine green fluorescence imaging was performed for enhanced anatomical precision. No conversion to multiport or open surgery was required.

Results: The median operative time was 201.1 min; the median hospital stay was 7.2 days. No major postoperative complications or readmissions were observed. One patient required a blood transfusion. All malignant cases achieved R0 resection; lymph node dissection was performed when indicated, and an average of 9.3 nodes was retrieved. Instrument articulation and visualization were optimized using the cobra mode, while floating port strategies were adopted based on the target location.

Conclusion: SP robotic liver resection is technically feasible and safe for major and minor hepatectomies. The platform overcomes many ergonomic and visualization challenges of SP laparoscopy while maintaining oncological integrity. Despite limitations, including the lack of integrated energy devices and reduced working space, the SP system offers cosmetic, precision, and ergonomic advantages. Our findings support the early adoption of SP robotic liver surgery, even in moderate-volume institutions.