Novel Surgical Technique of Liver Parenchyma Transection During Robotic‐Assisted Liver Resection: “Trac & Pac”

Abstract

BACKGROUND/PURPOSE: A standardized liver parenchymal transection method in robotic-assisted liver resection has not yet been established, and the techniques used vary among institutions. We developed a novel transection technique for robotic-assisted liver resection termed "Trac & Pac," which uses maryland bipolar forceps with a gentle stroking motion and strategic traction to progressively expose and dissect the liver parenchyma. METHODS: We described the technical details of "Trac & Pac" and Evaluated its short-term outcomes (2022-2025), comparing them with those of conventional laparoscopic liver resection using the Cavitron Ultrasonic Surgical Aspirator (CUSA) (2018-2022). RESULTS: The robotic-assisted liver resection group included 26 patients who underwent robotic left or right hepatectomy with the "Trac & Pac" technique, whereas the laparoscopic liver resection group comprised 34 patients who underwent laparoscopic left or right hepatectomy using the CUSA. The robotic group had a longer time from pneumoperitoneum to the start of intra-abdominal manipulation than the laparoscopic group (p < 0.001). Both groups had similar parenchymal transection times, blood loss, and postoperative complications. CONCLUSIONS: "Trac & Pac" is a safe and feasible robotic-assisted liver parenchymal transection technique that may provide a new solution for improving precision and exposure in minimally invasive liver surgery.