Advancing Robotic Liver Resection: The Sling Technique for Improved Hepatic Retraction

Abstract

Hepatic surgery, including laparoscopic liver resection, is well codified with difficulty scales on the basis of lesion position, particularly in the posterior segments, lesion size, and underlying liver disease.^1,2 These scores are transposable to robotic hepatic surgery.³ Tumors in segment 7 are particularly challenging to expose and are classified as difficult to access.⁴ Various techniques are used, such as mobilizing the liver with the gallbladder or the round ligament and employing a range of liver retractors. However, these retractors can be traumatic to the liver, are difficult to maneuver, and occupy an assistant's arm. Our team decided to utilize the "sling" technique, involving rolled surgical sponges shaped into a cylinder. This sling is placed behind the liver and gently retracted to mobilize it, bringing difficult-to-access areas into view for easier resection. The technique is atraumatic, easily manipulable, and frees up the assistant's arm for other tasks. It also aligns the transection plane with the camera, enhancing visualization during robotic liver surgery. This method is demonstrated through two surgical videos. The sling technique is a cost-efficient, easily reproducible, and effective method for hepatic retraction in robotic liver surgery. It overcomes the limitations of traditional retractors, offering enhanced exposure with minimal trauma to the liver. The described technique, demonstrated through surgical videos, highlights its practical application and benefits in minimally invasive hepatic surgery.

Keywords: Liver cancer; Liver resection; Minimally invasive; Robotic surgery.