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Background <p>Despite the advantages of robotic-assisted liver resection (RALR), intraoperative blood loss (IBL) remains a main concern in hepatic surgery. The current multicenter study was designed to evaluate the determinants of significant intraoperative bleeding in RALR and the clinical impact of such bleeding.</p> Methods <p>This study retrospectively analyzed 708 consecutive RALR performed in nine high-volume European centers between 2011 and 2023. All demographic, intraoperative, and postoperative data were extracted from a shared database. Patients were stratified into two groups based on the IBL value (&lt; 500 mL vs. ≥ 500 mL). Variables that reached the level of <i>p</i> &lt; 0.10 at univariable analysis were included in a multivariate logistic regression model.</p> Results <p>The mean IBL was 224.7 mL, and 9.6% of patients experienced IBL ≥ 500 mL. Both cirrhosis (OR 3.00, 95% CI 1.63–5.52; <i>p</i> &lt; 0.001) and higher TAMPA score (OR 1.09 per point, 95% CI 1.03–1.16; <i>p</i> = 0.004) independently predicted major bleeding. Patients with IBL ≥ 500 mL had longer operative times (372 vs. 239&#xa0;min, <i>p</i> &lt; 0.001), higher morbidity (72% vs. 46%, <i>p</i> &lt; 0.001), and greater mortality (4.4% vs. 0.6%, <i>p</i> = 0.022).</p> Conclusions <p>During RALR significant bleeding persists in 10% of cases. Cirrhosis and procedural complexity remain independent predictors. Early identification of the high-risk patient and tailored perioperative strategies are of paramount importance in reducing bleeding and improving overall outcomes following robotic hepatobiliary surgery.</p>

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When the robot bleeds: risk factors and outcomes of intraoperative blood loss in robotic liver resection

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月24日

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  • Silvio Caringi,
  • Antonella Delvecchio,
  • Rebecca Marino,
  • Paolo Magistri,
  • Andrea Belli,
  • Annarita Libia,
  • Graziano Ceccarelli,
  • Francesco Izzo,
  • Marcello Giuseppe Spampinato,
  • Nicola de’ Angelis,
  • Patrick Pessaux,
  • Tullio Piardi,
  • Fabrizio Di Benedetto,
  • Francesca Ratti,
  • Riccardo Memeo

摘要

Background

Despite the advantages of robotic-assisted liver resection (RALR), intraoperative blood loss (IBL) remains a main concern in hepatic surgery. The current multicenter study was designed to evaluate the determinants of significant intraoperative bleeding in RALR and the clinical impact of such bleeding.

Methods

This study retrospectively analyzed 708 consecutive RALR performed in nine high-volume European centers between 2011 and 2023. All demographic, intraoperative, and postoperative data were extracted from a shared database. Patients were stratified into two groups based on the IBL value (< 500 mL vs. ≥ 500 mL). Variables that reached the level of p < 0.10 at univariable analysis were included in a multivariate logistic regression model.

Results

The mean IBL was 224.7 mL, and 9.6% of patients experienced IBL ≥ 500 mL. Both cirrhosis (OR 3.00, 95% CI 1.63–5.52; p < 0.001) and higher TAMPA score (OR 1.09 per point, 95% CI 1.03–1.16; p = 0.004) independently predicted major bleeding. Patients with IBL ≥ 500 mL had longer operative times (372 vs. 239 min, p < 0.001), higher morbidity (72% vs. 46%, p < 0.001), and greater mortality (4.4% vs. 0.6%, p = 0.022).

Conclusions

During RALR significant bleeding persists in 10% of cases. Cirrhosis and procedural complexity remain independent predictors. Early identification of the high-risk patient and tailored perioperative strategies are of paramount importance in reducing bleeding and improving overall outcomes following robotic hepatobiliary surgery.