Technical complexity and perioperative outcomes of robotic central hepatectomy compared with right and left hepatectomy.

Central hepatectomy (CH) is considered one of the most technically demanding robotic major liver resections because of the large transection plane and the proximity to major biliovascular structures. However, direct comparisons between robotic CH, right (RH), and left hepatectomy (LH) are lacking. This study evaluated differences in technical complexity and perioperative outcomes among these procedures. Robotic hepatectomies performed between 2013 and 2024 were retrospectively reviewed. Patients were stratified into CH, RH, and LH groups. Continuous variables were analyzed using the Kruskal-Wallis test, categorical variables using the Chi-square or Fisher's exact test, with Bonferroni correction for pairwise comparisons. Ninety-nine patients were included: 11 CH,39 RH, and 49 LH. Multifocal disease was more frequent in CH than in RH and LH (45.4% vs. 7.7% and 8.2%; P = 0.008). Operative time differed among groups (P = 0.0003), being longer in CH and RH than in LH. Estimated blood loss also differed (P = 0.0001), with higher values in CH and RH. Length of stay and major complications were comparable. No conversions or in-hospital mortality occurred. Robotic CH is performed in a more complex oncological setting but achieves perioperative outcomes comparable to RH and LH. However, RH is associated with a longer operative time and greater estimated blood loss.