Short-pitch dividing method for robotic liver resection: a conceptual shift to close-to-open separation from open-to-close crushing

Robotic liver resection (RLR) commonly relies on the clamp crushing method because a dedicated robotic ultrasonic aspirator is unavailable. However, crushing-type maneuvers inherently risk injury to small vascular and biliary structures, and this risk may be amplified in RLR due to the absence of tactile feedback. This study introduces a novel parenchymal transection strategy—the short-pitch dividing method combined with a double-hand transection method—with five auxiliary techniques designed to mitigate limitations of the robotic platform. Consecutive patients undergoing RLR or laparoscopic liver resection (LLR) during 2019–2025 were reviewed. Perioperative outcomes were compared between groups. The short-pitch dividing method involves inserting the closed tip of the Maryland bipolar forceps into the liver parenchyma and then slightly opening it. Repeating this “close-to-open” motion rapidly and continuously enables controlled and atraumatic parenchymal division and facilitates early identification of small Glissonean pedicles and hepatic veins. The proportion of intermediate/high-complexity resections was significantly higher in the RLR groups than in the LLR group: 45.8% vs. 31.9%, P = 0.043. No patient developed bile leakage in the RLR group, compared with 6 patients (3.1%) in the LLR group. Median postoperative hospital stay was significantly shorter in the RLR group than in the LLR group (4 days vs. 6 days, P < 0.001). This study demonstrates a novel robotic parenchymal transection technique centered on the short-pitch dividing method, representing a conceptual shift from traditional “open-to-close” crushing techniques. This approach minimizes structural injury, and improves procedural efficiency, supporting its utility in RLR.