Impact of robotic approach on total operating room time and surgical workflow in minimally invasive liver resection (TAKUMI-8)

BACKGROUND: The adoption of minimally invasive liver resection (MILR) is increasing globally; however, the impact of robotic platforms on total operating room time (TORT) remains poorly investigated. This study aimed to compare the TORTs for robot-assisted liver resection (RLR) and laparoscopic liver resection (LLR) by analyzing five distinct surgical phases. METHODS: This single-center retrospective study included 268 patients who underwent pure MILR (166 RLR and 102 LLR) between January 2018 and December 2025. The TORT was divided into five surgical phases: in-room to cut time, cut to transection time, transection time, transection to close time, and close to wheel-out time. Multivariable linear regression analyses were performed to identify predictors of TORT. RESULTS: The median TORT was significantly shorter for RLR than for LLR (RLR vs. LLR; 254 vs. 352 min, P < 0.001). It was consistently shorter across almost all phases of the RLR: room-to-cut time (51 vs. 78 min, P < 0.001), cut-to-transection time (46 vs. 68 min, P < 0.001), transection time (56 vs. 98 min, P < 0.001), and transection to close time (50 vs. 63 min, P < 0.001). Multivariable analyses identified central venous catheterization (estimate: 17.4 min; 95% CI, 7.7-27.0; P < 0.001), posterosuperior tumor location (estimate: 31.8; 95% CI, 22.8-40.7; P < 0.001), anatomic resection (estimate: 35.4; 95% CI, 26.6-44.2; P < 0.001), and LLR (estimate: 43.9; 95% CI, 34.4-53.4; P < 0.001) as independent predictors of prolonged TORT. Phase-specific analysis revealed that the robotic approach was an independent factor for shortening all surgical phases, except for the close to wheels-out time. CONCLUSION: The TORT for RLR was significantly shorter because of reduced time requirements across nearly all surgical phases. The robotic approach may enhance the operational efficiency of the operating room workflow for MILR.