Robotic Anatomical Liver Resection for Segment 7 Lesions Utilizing Saline-Linked Cautery (SLiC) Method.

Introduction Anatomical hepatectomy for segment 7 (S7) lesions is technically challenging due to their restricted accessibility and close proximity to the right hepatic vein, and the robotic approach for this challenging situation is currently not supported by conclusive data. Methods We present our novel technique of robotic anatomical hepatectomy for S7 lesions utilizing the saline-linked cautery (SLiC) method. Between 2022 and 2023, 10 robotic S7 subsectionectomy or right posterior sectionectomy were performed and included in the current study. The historical control group included patients undergoing laparoscopic anatomical hepatectomy for S7 lesions between 2017 and 2021 (n=9). Surgical outcomes were compared between the groups to assess the efficacy and safety of our technical robotic approach for S7 lesions. Results There were no conversions to open liver resection, no cases of grade B or C post-hepatectomy liver failure, and no mortality in the whole cohort. Although no difference was found between the laparoscopic and robotic groups in the difficulty score, operative time, and rate of red blood cell transfusion, the robotic group had a significantly lesser amount of surgical blood loss (28mL vs. 280mL, p=0.005). Concerning postoperative complications, one patient had liver subcapsular hematoma in the robotic group, although neither bile leakage nor intraperitoneal abscess occurred in the whole cohort. Conclusions Although robotic right posterior sectionectomy and S7 subsectionectomy of the liver are technically demanding procedures, the intrahepatic Glissonean approach using the SLiC method is safe and feasible. It might be performed without increasing the incidence of postoperative complications. Thus, the current approach can be considered as one of the preferred options for robotic anatomical hepatectomy for S7 lesions.