Updated overview of robotic hepatic parenchymal transection techniques: technical developments, international perspectives, and future directions

Robotic liver surgery is rapidly evolving, and parenchymal transection remains one of its most technically challenging steps. A recent narrative review identified and classified 13 robotic liver transection techniques, distinguishing between hybrid and fully robotic approaches, as well as between one- and two-surgeon methods. One year later, a systematic literature review was conducted to provide an updated overview of recent technical innovations, to identify international guidelines or consensus statements related to robotic liver surgery, and to evaluate the availability of comparative studies assessing the performance and outcomes of different robotic liver parenchymal transection techniques or devices. Within this relatively short time frame, 5 novel transection techniques not included in the original classification were described. In addition, 6 publications reporting surveys, consensus statements, or international protocols, as well as 4 comparative studies, were identified. However, despite the growing number of publications on this topic, the absence of randomized controlled trials and the limited availability of high-quality comparative studies have hindered the development of definitive guidelines and the identification of a gold-standard transection method. Although robotic liver surgery is currently characterized by widespread enthusiasm and rapid adoption, the lack of standardization continues to limit reproducibility and complicates meaningful comparison of surgical outcomes across centers. An adaptive and flexible approach, in which surgical teams achieve proficiency in a “minimal core toolbox” of techniques and instruments and tailor their application according to procedural complexity and patient-specific factors, may represent a pragmatic strategy to enhance safety, reproducibility, and training in robotic liver surgery.