{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:24:11Z","timestamp":1786980251383,"version":"build-2736575974"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf (UKE)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Robotic operations are becoming increasingly important in minimally invasive liver surgery. Although safety and efficiency have already been demonstrated, real-world data regarding robotic experiences compared to laparoscopic procedures remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of all patients who underwent laparoscopic or robotic resection for malignant or benign liver tumors between January 2020 and June 2024 at the University Medical Center Hamburg-Eppendorf.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 308 patients met the inclusion criteria. Of these, 133 patients underwent robotic resection with the DaVinci\u00ae-Xi system, while 175 patients were operated laparoscopically. In the robotic cohort, major resections were performed more frequently (27 [20.3%] vs. 14 [8.0%];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Moreover, the rate of patients with liver cirrhosis was higher (34.6% vs. 20%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004), and more patients were classified as ASA 3\u20134 (61.7% vs. 48.6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.022). Additionally, a greater number of patients with hepatocellular carcinoma and biliary neoplasia underwent robotic resection (54.0% vs. 34.2%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Operation time was significantly shorter in the laparoscopic group (132\u00a0min vs. 187\u00a0min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). There were no statistically significant differences between groups for conversion rate, intraoperative blood loss, overall complication rate, and complications classified as\n                      <jats:inline-formula>\n                        <jats:alternatives>\n                          <jats:tex-math>$$\\ge$$<\/jats:tex-math>\n                          <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                            <mml:mo>\u2265<\/mml:mo>\n                          <\/mml:math>\n                        <\/jats:alternatives>\n                      <\/jats:inline-formula>\n                      3A according to the Clavien\u2013Dindo system.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In a real-world setting, we retrospectively observed a selection tendency favoring the robotic approach for multimorbid patients, particularly those with liver cirrhosis and primary malignant liver tumors with higher complexity, highlighting the evolving role of robotic surgery in managing complex liver resections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-025-12470-1","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T16:35:54Z","timestamp":1767630954000},"page":"2474-2482","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparison of laparoscopic and robotic liver surgery: a German real-world analysis"],"prefix":"10.1007","volume":"40","author":[{"given":"P. H.","family":"von Kroge","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Fard-Aghaie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Afshar-Bakshloo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. R.","family":"Izbicki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Hackert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Schmelzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Nickel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Ghadban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Heumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"12470_CR1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14174268","author":"E Bozkurt","year":"2022","unstructured":"Bozkurt E, Sijberden JP, Hilal MA (2022) What is the current role and what are the prospects of the robotic approach in liver surgery. Cancers (Basel). https:\/\/doi.org\/10.3390\/cancers14174268","journal-title":"Cancers (Basel)"},{"issue":"11","key":"12470_CR2","doi-asserted-by":"publisher","first-page":"1226","DOI":"10.1002\/jhbp.1087","volume":"29","author":"A Benedetti Cacciaguerra","year":"2022","unstructured":"Benedetti Cacciaguerra A, Gorgec B, Lanari J, Cipriani F, Russolillo N, Mocchegiani F et al (2022) Outcome of major hepatectomy in cirrhotic patients; does surgical approach matter? A propensity score matched analysis. J Hepatobiliary Pancreat Sci 29(11):1226\u20131239. https:\/\/doi.org\/10.1002\/jhbp.1087","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"4","key":"12470_CR3","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1016\/j.suronc.2018.10.005","volume":"27","author":"A Andreou","year":"2018","unstructured":"Andreou A, Struecker B, Raschzok N, Krenzien F, Haber P, Wabitsch S et al (2018) Minimal-invasive versus open hepatectomy for hepatocellular carcinoma: comparison of postoperative outcomes and long-term survivals using propensity score matching analysis. Surg Oncol 27(4):751\u2013758. https:\/\/doi.org\/10.1016\/j.suronc.2018.10.005","journal-title":"Surg Oncol"},{"key":"12470_CR4","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9124027","author":"S Knitter","year":"2020","unstructured":"Knitter S, Andreou A, Kradolfer D, Beierle AS, Pesthy S, Eichelberg AC et al (2020) Minimal-invasive versus open hepatectomy for colorectal liver metastases: bicentric analysis of postoperative outcomes and long-term survival using propensity score matching analysis. J Clin Med. https:\/\/doi.org\/10.3390\/jcm9124027","journal-title":"J Clin Med"},{"issue":"11","key":"12470_CR5","doi-asserted-by":"publisher","first-page":"1485","DOI":"10.1016\/j.hpb.2019.03.358","volume":"21","author":"DL Aghayan","year":"2019","unstructured":"Aghayan DL, Fretland AA, Kazaryan AM, Sahakyan MA, Dagenborg VJ, Bjornbeth BA et al (2019) Laparoscopic versus open liver resection in the posterosuperior segments: a sub-group analysis from the OSLO-COMET randomized controlled trial. HPB (Oxford) 21(11):1485\u201390. https:\/\/doi.org\/10.1016\/j.hpb.2019.03.358","journal-title":"HPB (Oxford)"},{"issue":"2","key":"12470_CR6","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1097\/SLA.0000000000002353","volume":"267","author":"AA Fretland","year":"2018","unstructured":"Fretland AA, Dagenborg VJ, Bjornelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW et al (2018) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg 267(2):199\u2013207. https:\/\/doi.org\/10.1097\/SLA.0000000000002353","journal-title":"Ann Surg"},{"issue":"10","key":"12470_CR7","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1016\/j.hpb.2021.03.006","volume":"23","author":"CM Haney","year":"2021","unstructured":"Haney CM, Studier-Fischer A, Probst P, Fan C, Muller PC, Golriz M et al (2021) A systematic review and meta-analysis of randomized controlled trials comparing laparoscopic and open liver resection. HPB (Oxford) 23(10):1467\u20131481. https:\/\/doi.org\/10.1016\/j.hpb.2021.03.006","journal-title":"HPB (Oxford)"},{"issue":"3","key":"12470_CR8","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1097\/SLA.0000000000003915","volume":"273","author":"H Muaddi","year":"2021","unstructured":"Muaddi H, Hafid ME, Choi WJ, Lillie E, de Mestral C, Nathens A et al (2021) Clinical outcomes of robotic surgery compared to conventional surgical approaches (laparoscopic or open): a systematic overview of reviews. Ann Surg 273(3):467\u2013473. https:\/\/doi.org\/10.1097\/SLA.0000000000003915","journal-title":"Ann Surg"},{"issue":"2","key":"12470_CR9","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1002\/jhbp.869","volume":"29","author":"R Ciria","year":"2022","unstructured":"Ciria R, Berardi G, Alconchel F, Briceno J, Choi GH, Wu YM et al (2022) The impact of robotics in liver surgery: a worldwide systematic review and short-term outcomes meta-analysis on 2728 cases. J Hepatobiliary Pancreat Sci 29(2):181\u201397. https:\/\/doi.org\/10.1002\/jhbp.869","journal-title":"J Hepatobiliary Pancreat Sci"},{"issue":"8","key":"12470_CR10","doi-asserted-by":"publisher","first-page":"5854","DOI":"10.1007\/s00464-021-08770-x","volume":"36","author":"M Schmelzle","year":"2022","unstructured":"Schmelzle M, Feldbrugge L, Ortiz Galindo SA, Moosburner S, Kastner A, Krenzien F et al (2022) Robotic vs. laparoscopic liver surgery: a single-center analysis of 600 consecutive patients in 6 years. Surg Endosc 36(8):5854\u201362. https:\/\/doi.org\/10.1007\/s00464-021-08770-x","journal-title":"Surg Endosc"},{"issue":"5","key":"12470_CR11","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1001\/jamasurg.2022.0161","volume":"157","author":"CC Chong","year":"2022","unstructured":"Chong CC, Fuks D, Lee KF, Zhao JJ, Choi GH, Sucandy I et al (2022) Propensity score-matched analysis comparing robotic and laparoscopic right and extended right hepatectomy. JAMA Surg 157(5):436\u201344. https:\/\/doi.org\/10.1001\/jamasurg.2022.0161","journal-title":"JAMA Surg"},{"key":"12470_CR12","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006523","author":"J Hu","year":"2024","unstructured":"Hu J, Guo Y, Wang X, Yeow M, Wu AGR, Fuks D et al (2024) Propensity score-matched analysis comparing robotic versus laparoscopic minor liver resections of the anterolateral segments: an International Multi-center Study of 10,517 cases. Ann Surg. https:\/\/doi.org\/10.1097\/SLA.0000000000006523","journal-title":"Ann Surg"},{"issue":"2","key":"12470_CR13","doi-asserted-by":"publisher","first-page":"205","DOI":"10.21037\/hbsn-22-283","volume":"12","author":"TT Cheung","year":"2023","unstructured":"Cheung TT, Liu R, Cipriani F, Wang X, Efanov M, Fuks D et al (2023) Robotic versus laparoscopic liver resection for huge (>\/=10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases. Hepatobiliary Surg Nutr 12(2):205\u201315. https:\/\/doi.org\/10.21037\/hbsn-22-283","journal-title":"Hepatobiliary Surg Nutr"},{"issue":"3","key":"12470_CR14","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1308\/rcsann.2011.93.3.185a","volume":"93","author":"J Fitz-Henry","year":"2011","unstructured":"Fitz-Henry J (2011) The ASA classification and peri-operative risk. Ann R Coll Surg Engl 93(3):185. https:\/\/doi.org\/10.1308\/rcsann.2011.93.3.185a","journal-title":"Ann R Coll Surg Engl"},{"issue":"2","key":"12470_CR15","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","volume":"240","author":"D Dindo","year":"2004","unstructured":"Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205\u201313. https:\/\/doi.org\/10.1097\/01.sla.0000133083.54934.ae","journal-title":"Ann Surg"},{"issue":"4","key":"12470_CR16","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.surg.2018.10.012","volume":"165","author":"S Tanaka","year":"2019","unstructured":"Tanaka S, Kawaguchi Y, Kubo S, Kanazawa A, Takeda Y, Hirokawa F et al (2019) Validation of index-based IWATE criteria as an improved difficulty scoring system for laparoscopic liver resection. Surgery 165(4):731. https:\/\/doi.org\/10.1016\/j.surg.2018.10.012","journal-title":"Surgery"},{"issue":"3","key":"12470_CR17","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1097\/SLA.0b013e31825a01f6","volume":"257","author":"SM Strasberg","year":"2013","unstructured":"Strasberg SM, Phillips C (2013) Use and dissemination of the Brisbane 2000 nomenclature of liver anatomy and resections. Ann Surg 257(3):377\u201382. https:\/\/doi.org\/10.1097\/SLA.0b013e31825a01f6","journal-title":"Ann Surg"},{"issue":"5","key":"12470_CR18","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1016\/j.surg.2010.12.002","volume":"149","author":"M Koch","year":"2011","unstructured":"Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149(5):680. https:\/\/doi.org\/10.1016\/j.surg.2010.12.002","journal-title":"Surgery"},{"key":"12470_CR19","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006759","author":"Z Li","year":"2025","unstructured":"Li Z, Pfister M, Raptis DA, Ma Y, Yang G, Li L et al (2025) Novel benchmark for robotic liver resection\u2014bridging tradition with innovation. Ann Surg. https:\/\/doi.org\/10.1097\/SLA.0000000000006759","journal-title":"Ann Surg"},{"issue":"3","key":"12470_CR20","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1177\/1457496920925637","volume":"110","author":"SK Kamarajah","year":"2021","unstructured":"Kamarajah SK, Bundred J, Manas D, Jiao L, Hilal MA, White SA (2021) Robotic versus conventional laparoscopic liver resections: a systematic review and meta-analysis. Scand J Surg 110(3):290\u2013300. https:\/\/doi.org\/10.1177\/1457496920925637","journal-title":"Scand J Surg"},{"issue":"4","key":"12470_CR21","doi-asserted-by":"publisher","first-page":"e527","DOI":"10.1097\/AS9.0000000000000527","volume":"5","author":"G Pilz da Cunha","year":"2024","unstructured":"Pilz da Cunha G, Sijberden JP, van Dieren S, Gobardhan P, Lips DJ, Terkivatan T et al (2024) Robotic versus laparoscopic liver resection: a Nationwide propensity score matched analysis. Ann Surg Open 5(4):e527. https:\/\/doi.org\/10.1097\/AS9.0000000000000527","journal-title":"Ann Surg Open"},{"issue":"1","key":"12470_CR22","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1097\/SLA.0000000000006267","volume":"280","author":"JP Sijberden","year":"2024","unstructured":"Sijberden JP, Hoogteijling TJ, Aghayan D, Ratti F, Tan EK, Morrison-Jones V et al (2024) Robotic versus laparoscopic liver resection in various settings: an International Multicenter Propensity Score Matched Study of 10.075 patients. Ann Surg 280(1):108\u201317. https:\/\/doi.org\/10.1097\/SLA.0000000000006267","journal-title":"Ann Surg"},{"issue":"9","key":"12470_CR23","doi-asserted-by":"publisher","first-page":"2241","DOI":"10.1007\/s00268-023-07060-y","volume":"47","author":"T Winckelmans","year":"2023","unstructured":"Winckelmans T, Wicherts DA, Parmentier I, De Meyere C, Verslype C, D\u2019Hondt M (2023) Robotic versus laparoscopic hepatectomy: a single surgeon experience of 629 consecutive minimally invasive liver resections. World J Surg 47(9):2241\u20132249. https:\/\/doi.org\/10.1007\/s00268-023-07060-y","journal-title":"World J Surg"},{"issue":"4","key":"12470_CR24","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1016\/j.asjsur.2020.12.016","volume":"44","author":"Y Hu","year":"2021","unstructured":"Hu Y, Guo K, Xu J, Xia T, Wang T, Liu N et al (2021) Robotic versus laparoscopic hepatectomy for malignancy: a systematic review and meta-analysis. Asian J Surg 44(4):615\u2013628. https:\/\/doi.org\/10.1016\/j.asjsur.2020.12.016","journal-title":"Asian J Surg"},{"issue":"4","key":"12470_CR25","doi-asserted-by":"publisher","first-page":"e839","DOI":"10.1097\/SLA.0000000000005530","volume":"277","author":"BKP Goh","year":"2023","unstructured":"Goh BKP, Han HS, Chen KH, Chua DW, Chan CY, Cipriani F et al (2023) Defining global benchmarks for laparoscopic liver resections: an international multicenter study. Ann Surg 277(4):e839\u2013e848. https:\/\/doi.org\/10.1097\/SLA.0000000000005530","journal-title":"Ann Surg"},{"issue":"1","key":"12470_CR26","doi-asserted-by":"publisher","first-page":"107252","DOI":"10.1016\/j.ejso.2023.107252","volume":"50","author":"J Zheng","year":"2024","unstructured":"Zheng J, Liang X, Wu AGR, Kabir T, Scatton O, Lim C et al (2024) Impact of liver cirrhosis, severity of cirrhosis and portal hypertension on the difficulty of laparoscopic and robotic minor liver resections for primary liver malignancies in the anterolateral segments. Eur J Surg Oncol 50(1):107252. https:\/\/doi.org\/10.1016\/j.ejso.2023.107252","journal-title":"Eur J Surg Oncol"},{"issue":"1","key":"12470_CR27","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1245\/s10434-023-14376-5","volume":"31","author":"F Cipriani","year":"2024","unstructured":"Cipriani F, Aldrighetti L, Ratti F, Wu AGR, Kabir T, Scatton O et al (2024) Impact of liver cirrhosis, severity of cirrhosis, and portal hypertension on the difficulty and outcomes of laparoscopic and robotic major liver resections for primary liver malignancies. Ann Surg Oncol 31(1):97\u2013114. https:\/\/doi.org\/10.1245\/s10434-023-14376-5","journal-title":"Ann Surg Oncol"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-12470-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-025-12470-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-025-12470-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T19:35:02Z","timestamp":1773084902000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-025-12470-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":27,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["12470"],"URL":"https:\/\/doi.org\/10.1007\/s00464-025-12470-1","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]},"assertion":[{"value":"2 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Philipp H. von Kroge, Mohammad H. Fard-Aghaie, Kijan Afshar-Bakshloo, Jakob R. Izbicki, Thilo Hackert, Jun Li, Indra Schmelzer, Felix Nickel, Tarik Ghadban, and Asmus Heumann have no conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}