Challenging anatomy, comparable outcomes: a multicenter propensity score-matched analysis of robotic hepatectomy in posterosuperior versus anterolateral segments

Introduction: Robotic liver resection has become increasingly adopted for minor hepatectomies, including lesions in the anatomically challenging posterosuperior (PS) segments. This study compares the perioperative and pathological outcomes of robotic minor resections in PS versus anterolateral (AL) segments across high-volume centers in Europe. Materials and methods: A multicenter database of 730 robotic liver resections performed from 2011 to 2023 in nine European institutions was reviewed. After excluding major hepatectomies, patients were analyzed in three steps: overall cohort, comparison of PS vs AL resections, and two consecutive propensity score matches. Results: PS resections consistently had longer operative times, increased blood loss, and increased frequency and duration of Pringle maneuver use in all analyses. Following propensity matching, postoperative outcome measures such as overall morbidity, major complications, readmission, mortality, length of stay, and R1 rates were similar for PS and AL resections. Discussion: Despite greater intraoperative complexity, robotic surgery seems to offset the technical disadvantages of PS segments to obtain postoperative and pathological results comparable to AL resections. Conclusion: Robotic minor liver resections in PS segments are safe and feasible when performed in experienced centers, supporting their broader adoption in advanced minimally invasive hepatobiliary surgery.