MAMBA (Moisture Assisted Multiple BipolAr) technique vs Robo-lap approach in robotic liver resection. Is it possible a full robotic approach for parenchymal transection? A propensity score matching analysis.

Background: Robotic surgery is becoming more and more widespread. Despite its diffusion, parenchymal transection still remains a matter of debate. Up to now, in minimally invasive surgery, most of liver resection were performed laparoscopically with the support of ultrasonic dissector. The absence of robotic ultrasonic dissector is replaced by the hybrid (Robo-lap) technique in which the use of laparoscopic ultrasonic dissector is merged with the use of robotic energy devices in order to perform parenchymotomy. On the other side, some surgical groups perform liver resection using only Da Vinci energy devices, focusing on the simultaneous use of the double bipolar forceps (Maryland and bipolar) and applying the clamp-crush technique during robotic resection (MAMBA-Moisture Assisted Multiple BipolAr). Aim of our study is to compare intra- and post-operative outcomes of these two techniques.

Methods: We collected a multicenter retrospective database, including 1070 consecutive robotic liver resection in 10 European Hospital Centers. Among these, 921 patients underwent liver resection for malignancies. Perioperative data for each patient were analyzed. Patients were also divided in two groups according to parenchymal transection technique (MAMBA vs robo-lap). Perioperative data were compared between 2 groups before and after 1:1 Propensity Score Matching.

Results: 755 resection were performed by MAMBA technique, 166 resection by Robo-lap. After PSM, 91 patients were included in each group. There were no significant differences between two groups regarding operative time, estimated blood loss, conversion rate, and post-operative complications.

Conclusion: MAMBA technique is a valid alternative in robotic liver parenchymal transection, overcoming the lack of ultrasound devices.