• intrahepatic glissonean approach
• robotic anatomical liver resection
• robotic right posterior sectionectomy
• robotic segment 7 subsectionectomy
• saline-linked cautery method

• Glissonean approach
• bipolar forceps
• clamp‐crush technique
• robotic left hepatectomy
• saline drip
• saline‐linked

• Hepatectomy/methods
• Humans
• Robotic Surgical Procedures/methods
• Robotic Surgical Procedures/instrumentation
• Male
• Female
• Operative Time
• Middle Aged
• Aged
• Liver/surgery
• Blood Loss, Surgical/prevention & control
• Liver Neoplasms/surgery
• Length of Stay
• Adult
• Treatment Outcome
• Surgical Instruments

• postoperative complication
• robotic anatomical hepatectomy
• robotic liver resection
• robotic non-anatomical hepatectomy
• saline-linked cautery method

• energy device
• liver resection
• liver surgery
• surgical device
• surgical oncology

• Humans
• Follow-Up Studies
• Hepatectomy/adverse effects
• Liver/surgery
• Prospective Studies
• Ultrasonics

• laparoscopic liver resection
• learning curve
• modified two-surgeon technique
• on-the-job training
• surgeons-in-training

• anatomical s7 subsectionectomy
• hepatocellular carcinoma
• liver parenchymal transection
• robotic liver resection
• saline-linked cautery scissors

• bipolar forceps
• clamp-crush technique
• liver parenchymal transection
• liver surgery
• robotic liver resection
• saline drip
• saline-linked

Introduction

Although there are a number of benefits to using robotics in liver surgery over conventional open and laparoscopic approaches, liver parenchymal transection is still the most difficult aspect of robotic liver resection (RLR) due to the limitations of the currently available robotic instruments and the lack of a standardized method.

Methods

We present a novel method for transecting the liver parenchyma during RLR employing saline-linked monopolar cautery (SLiC) scissors (SLiC-Scissors method). Between September 2021 and April 2022, 10 RLRs were performed utilizing the SLiC-Scissors method for both anatomical and non-anatomical liver resections. We assessed the short-term results, as well as the safety and practicality of our robotic liver parenchymal transection technique.

Results

Six of the 10 patients had malignant liver tumors, and four of them had liver metastases from colorectal cancer. Except for S1, the target lesions were present everywhere, and their median size was 25 mm (14-43 mm). The median amount of intraoperative bleeding was 5 mL (5-30 mL), and the median operative and console times were 223 and 134 min, respectively. There were no conversions to open liver resections. The median length of the postoperative stay was seven (4-13) days, and there were no serious postoperative complications or mortality.

Conclusions

The SLiC-Scissors method is a safe and practical procedure for liver parenchymal transection in RLR. In order to standardize and broadly implement RLR into normal patient treatment, this unique approach enables an advanced, locally controlled preparation of intrahepatic vessels and bile ducts.

Introduction: Although laparoscopic hepatectomy has the potential advantage of reducing intraoperative blood loss, it is more difficult to control bleeding laparoscopically compared to an open approach. We introduced a novel hemostatic technique, the saline-linked electrocautery combined with wet oxidized cellulose (SLiC-WOC) method, during laparoscopic hepatectomy where a combination of saline-linked electrocautery (SLiC) and wet oxidized cellulose (WOC) is used. This study aimed to investigate the feasibility of employing the SLiC-WOC method for laparoscopic hepatectomy.

Methods: Thirteen patients who underwent laparoscopic liver resection with the SLiC-WOC method between 2019 and 2020 were included in this study. The number of bleeding episodes in which the SLiC-WOC method was applied was counted, and the time required to achieve complete hemostasis was measured.

Results: Among the bleeding events that were difficult to achieve hemostasis by SLiC alone, 94% were safely and efficiently controlled. Additionally, 69% of hemostasis was achieved within 60 seconds and 91% within 120 seconds. Postoperatively, most patients experienced no complications and no operative mortality was observed.

Conclusions: The SLiC-WOC method can provide safe and time-efficient hemostasis during laparoscopic hepatectomy. This is especially crucial for bleeding, which is difficult to control using electrocautery alone.

While minimizing intraoperative blood loss during liver resection is one of the most important tasks, it is more difficult to control the refractory bleeding during laparoscopic liver resection than with an open approach. We herein provide a modification of the two-surgeon technique that enables laparoscopic liver parenchymal transection to be performed as quickly and securely as open liver resection. To achieve proper "role sharing," the "transection mode" and the "hemostatic mode" are independent sets in place in this procedure, and these modes are switched rigidly according to the surgical field condition. By thoroughly sharing the roles, rapid laparoscopic liver parenchymal transection comparable to open liver resection can be accomplished. The present modified approach achieves satisfactory transection and hemostasis of the liver parenchyma and is also advantageous for teaching young surgeons and the entire surgical team.

• Future liver remnant
• Heterogeneity
• Liver function test
• SPECT
• Volumetry

• diagnostic imaging
• fluorescence
• hepatectomy
• hepatic veins
• indocyanine green

• Bare area
• Cadaver
• Diaphragm
• Laennec’s capsule
• Liver

Right-sided ligamentum teres (RSLT) is a congenital anomaly in which the right umbilical ligament becomes dominant and anomalous ramifications of the hepatic vessels and biliary system are present. A male patient in his 70s was diagnosed with advanced gallbladder cancer directly infiltrating the right hepatic duct (RHD), together with RSLT. Preoperative three-dimensional simulation of the liver based on multiple detector computed tomography images after cholangiography revealed ramifications of all segmental portal veins from the portal trunk and discordance of the arterial and biliary branching patterns of segment 8. Fusion analysis of the biliary architecture and segmental volumetry showed that the RHD drained segments 1r, 5, 6, and 7. We successfully performed a modified right-sided hepatectomy sparing segment 8 (i.e., resection of the RHD drainage territory), with negative surgical margins. This report is the first to describe major hepatectomy for advanced gallbladder cancer with RSLT.

• Right-sided ligamentum teres
• Hepatectomy
• Gallbladder cancer
• Preoperative liver simulation
• Anomaly of the portal vein

• Adult
• Aged
• Blood Loss, Surgical/prevention & control
• Catheter Ablation
• Feasibility Studies
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Jejunostomy/methods
• Liver Function Tests
• Male
• Middle Aged
• Retrospective Studies
• Time Factors
• Treatment Outcome

• GSA SPECT
• Indocyanine green
• Liver function

• Animals
• Blood Coagulation
• Chickens
• Feedback
• Hemostasis
• Laparoscopy/instrumentation
• Liver/surgery
• Robotics/instrumentation
• Spleen/surgery
• Steam
• Sus scrofa
• Tissue Adhesions/surgery
• Touch

• Cavitation effect
• Liver resection
• Skeletonization
• Ultrasonic scalpel

• Electrocautery
• Hepatic parenchymal transection
• Water irrigation channel

Hepatic tumors in the lower edge and lateral segments are commonly treated by laparoscopic liver resection. Tumors in the anterosuperior and posterior segments are often large and locally invasive, and resection is associated with a higher risk of insufficient surgical margins, massive intraoperative bleeding, and breaching of the tumor. Laparoscopic surgery for such tumors often involves major hepatectomy, including resection of a large volume of normal liver tissue. We developed a novel method of laparoscopic resection of tumors in these segments with the patient in the semiprone position, using a dual-handling technique with an intercostal transthoracic port. The aim of this study was to evaluate the safety and usefulness of our technique.

Of 160 patients who underwent laparoscopic liver resection at our center from June 2008 to May 2013, we retrospectively reviewed those with tumors in the anterosuperior and posterior segments. Patients were placed supine or semilateral during surgery until January 2010 and semiprone from February 2010.

Before the introduction of the semiprone position in February 2010, a total of 7 of 40 patients (17.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection, and after introduction of the semiprone position, 69 of 120 patients (57.5 %) with tumors in the anterosuperior and posterior segments underwent laparoscopic liver resection (P < 0.001). There were no conversions to open surgery, reoperations, or deaths. The semiprone group had a significantly higher proportion of patients who underwent partial resection or segmentectomy of S7 or S8, lower intraoperative blood loss, and shorter hospital stay than the supine group (all P < 0.05). Postoperative complication rates were similar between groups.

Laparoscopic liver resection in the semiprone position is safe and increases the number of patients who can be treated by laparoscopic surgery without increasing the frequency of major hepatectomy.

The online version of this article (doi:10.1007/s00464-014-3469-y) contains supplementary material, which is available to authorized users.

Liver resections are demanding operations which can have life threatening complications although they are performed by experienced liver surgeons. The parameter “Blood Loss” has a central role in liver surgery, and different strategies to minimize it are a key to improve results. Moreover, recently, new technologies are applied in the field of liver surgery, having one goal: safer and easier liver operations. The aim of this paper is to review the different principal solutions to the problem of blood loss in hepatic surgery, focusing on technical aspects of new devices.

Hand-assisted laparoscopic liver surgery, a newly developed technique based on an innovative concept, has proved useful and safe for a variety of less invasive hepatectomies. Radiofrequency-assisted hepatic resection has been reported to be safe, associated with minimal morbidity and mortality and decreased intraoperative blood loss and transfusion requirements.

We describe how we perform hand-assisted laparoscopic radiofrequency-assisted hepatic resection using a bipolar radiofrequency device.

The use of the hand port has allowed the surgeon to use his hand in direct liver manipulation, mobilization, and retraction. It was also useful for tactile tumour localization. Radiofrequency-assisted hepatic parenchymal transection was performed on 15 patients using a bipolar device (Habib 4X) with minimal blood loss (74 ml), and very decent operative and resection times (92 min, 33 min respectively).

This combined procedure offers a safe, effective and rapid liver resection technique. This might encourage surgeons to perform a minimally invasive approach for liver resection more frequently.

• hand-assisted
• laparoscopic liver resection
• radiofrequency-assisted

• liver resection
• radiofrequency ablation
• intraoperative blood loss reduction

• Adult
• Aged
• Aged, 80 and over
• Blood Loss, Surgical/prevention & control
• Electrocoagulation
• Female
• Hemostasis, Surgical/instrumentation
• Hepatectomy/instrumentation
• Humans
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Time Factors

• Kelly clamp–crush technique
• Liver resection
• MELD score
• radiofrequency-assisted technique

• disease-free survival
• indocyanin green test
• overall survival
• post-operative complication

• Liver transection
• bipolar coagulation
• clamp crushing
• ultrasonic dissector

• Animals
• Catheter Ablation/instrumentation
• Catheter Ablation/methods
• Hemostatic Techniques
• Hepatectomy/methods
• Liver/surgery
• Models, Animal
• Swine