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Page 4 of 9 Nota et al. Mini-invasive Surg 2020;4:74 I http://dx.doi.org/10.20517/2574-1225.2020.57

Table 1. Patient characteristics
Parameter Outcome
Year of surgery, n (%)
2014 3 (4)
2015 9 (13)
2016 9 (13)
2017 19 (27)
2018 28 (40)
2019 (up to January 11th) 2 (3)
Age, mean (SD), years 60 (14)
Sex, male, n (%) 35 (50)
BMI, mean (SD), kg/m 2 27 (5)
ASA score, n (%) 1
ASA 1 3 (4)
ASA 2 49 (70)
ASA 3 16 (23)
Previous abdominal surgery, n (%) 45 (64)
Redo liver resection, n (%) 6 (9)
Indication for resection, n (%)
CRLM 32 (46)
Metastases, other 7 (10)
HCC 16 (23)
Cholangiocarcinoma 5 (7)
Other 10 (14)
1
Two missing values. SD: standard deviation; BMI: body mass index; ASA: American Society of Anesthesiologists; CRLM: colorectal liver
metastases; HCC: hepatocellular carcinoma

Hitachi Aloka Medical Inc., Wallingford, CT, USA). The latter provides more freedom of movement and
hence facilitates imaging of the posterosuperior segments more easily. A Pringle manoeuvre was applied
when deemed appropriate. The Vessel Sealer (Extend) was combined with the Maryland Bipolar Forceps
and Fenestrated Bipolar Forceps. The Vessel Sealer was employed by clamp-crushing thin layers of tissue
(as much as possible under direct vision to avoid lacerations of small veins and bile ducts) with subsequent
double sealing and cutting, working in layers from superficial to deep in the liver parenchyma as shown
previously [17,18] . Hem-o-lok clips (Teleflex Inc., Morrisville, NC, USA) or laparoscopic Endo GIA (Medtronic,
Minneapolis, MN, USA) were used for control of the hepatic pedicles and larger branches of the hepatic
veins, where appropriate.

RESULTS
In total, 70 resections were performed in 68 patients. Two patients underwent robotic liver resection twice
for recurrent hepatocellular carcinoma.

Patient characteristics
Patient characteristics are summarized in Table 1. The majority of liver resections was performed for
colorectal liver metastases (n = 32; 46%).

Operative characteristics and histopathological outcomes
Details on the surgical procedures and pathology are provided in Table 2. Five procedures were converted
to laparotomy, for several reasons: in three cases there was a lack of anatomical overview during transection
of the hepatic parenchyma; one patient had severe intra-abdominal adhesions; and in one patient a safe
oncological margin could not be assured robotically.

In all procedures the Vessel Sealer was used for parenchymal transection. In 22 procedures (31%) stapling
devices were also used to control the hepatic pedicles; these resections were left lateral sectionectomies