Initial Clinical Experience With Robotic Liver Resection Using the Saroa Surgical System: Practical Feasibility and Technical Challenges

Abstract

Introduction

The Saroa Surgical System is a newly developed robotic platform with force-feedback capability and a compact, relatively low-cost design. This study aimed to report our initial clinical experience with robotic liver resection using the Saroa Surgical System, with particular emphasis on its feasibility, safety, practical advantages, and the technical challenges encountered during the early implementation phase.

Methods

This retrospective case series included the first eight consecutive patients who underwent Saroa-assisted robotic liver resection at our institution between November 2024 and August 2025. The selected patients had superficial liver lesions that did not require anatomical resection. Clinical characteristics and short-term perioperative outcomes were descriptively analyzed.

Results

Eight patients underwent partial hepatectomy: five had hepatocellular carcinoma, two had metastatic liver tumors, and one had intrahepatic cholangiocarcinoma. The median operative time, console time, hepatic inflow occlusion time, and blood loss were 267 min, 136 min, 41 min, and 17.5 mL, respectively. Three patients required unplanned conversion to laparoscopy, which was performed smoothly using a port configuration compatible with laparoscopic surgery. One patient who underwent a third hepatectomy developed postoperative bile leakage (Clavien–Dindo grade IIIa). The median length of postoperative hospital stay was 10 days.

Conclusion

Robotic liver resection using the Saroa Surgical System was feasible in selected patients during the introductory phase. Its compatibility with the laparoscopic workflow, compact design, and force-feedback capability may offer practical advantages. However, the restricted working range, limited instrument availability, and relatively low grasping force remain as limitations.