Evaluation of Techniques and Utility of Liver Parenchymal Transection Using Robotic Ultrasonic Shears (da Vinci System) in Robot-Assisted Hepatectomy.

Abstract

PurposeLiver transection techniques in robotic liver resection (RLR) have not yet been standardized. We introduced robotic ultrasonic shears (longitudinal clustered shears [LCS]); however, the lack of an articulating joint limits operative angles. To overcome this, we implemented strategic surgical maneuvers. This study aimed to evaluate the liver transection efficiency of the robotic ultrasonic shears in RLR.MethodsFifty-three patients who underwent RLR concurrently between 2023 and 2025 were retrospectively analyzed (LCS group, n = 23; conventional [CONV] group using Maryland bipolar forceps, n = 30). We compared liver transection speed, total ischemia time, and short-term outcomes.ResultsDespite a lower proportion of low-difficulty cases in the LCS group, it demonstrated significantly higher transection speed (median: 0.71 vs 0.38 cm²/min, P < .001) and shorter total ischemia time (63 vs 78 min, P = .011). Postoperative albumin levels on days 3 and 5 were significantly higher (P = .004), and the complication rate (Clavien-Dindo grade ≥ II) was significantly lower (8.7% vs 30.0%, P = .049) in the LCS group. Multivariate analysis identified the use of LCS (P = .003) as an independent predictor of higher transection speed. Exploratory subgroup analyses confirmed that the LCS group had significantly higher transection speed in non-anatomical resections (P < .001) and significantly shorter ischemia time in anatomical resections (P = .021), although the higher transection speed in anatomical resections did not reach statistical significance.ConclusionsRobotic ultrasonic shears with optimized maneuvers significantly improve transection speed and reduce ischemia time, enhancing the efficiency of RLR.