Background/Purpose: Surgical outcomes and utility of robotic liver resection (RLR) are undefined. Methods: We retrospectively studied perioperative and long-term outcomes of the single-center 120 RLRs including non-anatomic (NAR, n = 58) and anatomic (AR, n = 62) resections. To evaluate the feasibility and safety of RLR, perioperative outcomes of RLR (n = 103) were compared to those of open (OLR, n = 495) or laparoscopic (LLR, n = 451) resection in liver-only resections without reconstruction, using 1:1 propensity score matching (PSM). The changing trends from the earlier to the later RLR cases were assessed. Long-term outcomes were compared between RLR and LLR.Results: Various types of RLR with different surgical difficulties were performed, with mostly comparable postoperative morbidity between AR and NAR, or among AR subtypes. In segmentectomy and sectionectomy cases, perioperative outcomes significantly improved in the later period. In comparison between PSM-selected OLR and RLR cases (87:87), RLR had significantly longer operative time, less blood loss, and shorter hospital stay. PSM-selected LLR and RLR cases (91:91) showed comparable perioperative outcomes. Overall and recurrence-free survivals after RLR for newly diagnosed hepatocellular carcinoma and colorectal metastasis were comparable to those after LLR.Conclusions: RLR is applicable to various types of liver resection with acceptable perioperative and long-term outcomes in select patients.

Surgical techniques and outcomes of minimally invasive anatomic liver resection (AR) using the extrahepatic Glissonian approach for hepatocellular carcinoma (HCC) are undefined. In 327 HCC cases undergoing 185 open (OAR) and 142 minimally invasive (MIAR; 102 laparoscopic and 40 robotic) ARs, perioperative and long-term outcomes were compared between the approaches, using propensity score matching. After matching (91:91), compared to OAR, MIAR was significantly associated with longer operative time (643 vs. 579 min, p = 0.028); less blood loss (274 vs. 955 g, p < 0.0001); a lower transfusion rate (17.6% vs. 47.3%, p < 0.0001); lower rates of major 90-day morbidity (4.4% vs. 20.9%, p = 0.0008), bile leak or collection (1.1% vs. 11.0%, p = 0.005), and 90-day mortality (0% vs. 4.4%, p = 0.043); and shorter hospital stay (15 vs. 29 days, p < 0.0001). On the other hand, laparoscopic and robotic AR cohorts after matching (31:31) had comparable perioperative outcomes. Overall and recurrence-free survivals after AR for newly developed HCC were comparable between OAR and MIAR, with potentially improved survivals in MIAR. The survivals were comparable between laparoscopic and robotic AR. MIAR was technically standardized using the extrahepatic Glissonian approach. MIAR was safe, feasible, and oncologically acceptable and would be the first choice of AR in selected HCC patients.

COVID-19 due to SARS-CoV-2 spread from China in December 2019 and is still a worldwide problem in August 2022. The seventh wave of the epidemic has arrived in Japan, and the number of infected patients is increasing. We report here our experience with a case of COVID-19 1 month after living donor liver transplantation. A 69-year-old female with decompensated cirrhosis due to nonalcoholic steatohepatitis underwent living donor liver transplantation. The donor was her 43-year-old daughter, and the graft was from the right lobe of the liver. The patient had postoperative bile leak and underwent reoperation on postoperative day 4, but otherwise, the postoperative course was generally good. The recipient's blood type was B Rh+ and the donor's blood type was A Rh+. The patient was immunosuppressed with FK, MMF, and steroids after surgery. On postoperative day 32, the patient developed a sore throat, hoarseness, and low-grade fever. PCR test was positive for SARS-CoV-2, and the patient was diagnosed with COVID-19. Respiratory failure was not observed, and the patient was considered mild illness. Remdesivir 200 mg/ day was administered for 3 days, and the dose of MMF was reduced to half. FK and steroids were continued at the same dose, however, FK was measured daily at trough level. Symptoms disappeared 3 days after the onset of the disease, and the trough level of FK passed without significant change. With the spread of COVID-19 infection, the number of cases of COVID-19 after transplantation is likely to increase, and accumulation and analysis of medical data is desirable.

Robotic surgery has technical advantages including high optical magnification and articulation of forceps. However, the surgical field tends to be narrow due to the high magnification, and the forceps have no tactile sensation. A case of

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