{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T12:26:48Z","timestamp":1786796808221,"version":"build-2736575974"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Surg Innov"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Liver transection techniques in robotic liver resection (RLR) have not yet been standardized. We introduced robotic ultrasonic shears (longitudinal clustered shears [LCS]); however, the lack of an articulating joint limits operative angles. To overcome this, we implemented strategic surgical maneuvers. This study aimed to evaluate the liver transection efficiency of the robotic ultrasonic shears in RLR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifty-three patients who underwent RLR concurrently between 2023 and 2025 were retrospectively analyzed (LCS group, n = 23; conventional [CONV] group using Maryland bipolar forceps, n = 30). We compared liver transection speed, total ischemia time, and short-term outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Despite a lower proportion of low-difficulty cases in the LCS group, it demonstrated significantly higher transection speed (median: 0.71 vs 0.38\u00a0cm\n                      <jats:sup>2<\/jats:sup>\n                      \/min,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and shorter total ischemia time (63 vs 78\u00a0min,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .011). Postoperative albumin levels on days 3 and 5 were significantly higher (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .004), and the complication rate (Clavien\u2013Dindo grade \u2265 II) was significantly lower (8.7% vs 30.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .049) in the LCS group. Multivariate analysis identified the use of LCS (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .003) as an independent predictor of higher transection speed. Exploratory subgroup analyses confirmed that the LCS group had significantly higher transection speed in non-anatomical resections (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and significantly shorter ischemia time in anatomical resections (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .021), although the higher transection speed in anatomical resections did not reach statistical significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Robotic ultrasonic shears with optimized maneuvers significantly improve transection speed and reduce ischemia time, enhancing the efficiency of RLR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15533506261477024","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T07:53:02Z","timestamp":1786521182000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluation of Techniques and Utility of Liver Parenchymal Transection Using Robotic Ultrasonic Shears (da Vinci System) in Robot-Assisted Hepatectomy"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2043-9099","authenticated-orcid":false,"given":"Daisuke","family":"Satoh","sequence":"first","affiliation":[{"name":"Hiroshima City Hiroshima Citizens Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryuichi","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Hiroshima City Hiroshima Citizens Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masashi","family":"Yoshimoto","sequence":"additional","affiliation":[{"name":"Hiroshima City Hiroshima Citizens Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Mashima","sequence":"additional","affiliation":[{"name":"Hiroshima City Hiroshima Citizens Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyoshi","family":"Matsukawa","sequence":"additional","affiliation":[{"name":"Hiroshima City Hiroshima Citizens Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.138.7.777"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v25.i12.1432"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006267"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2018.11.011"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-015-4284-9"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-024-16350-1"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-0266-7"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-024-01842-9"},{"issue":"3","key":"e_1_3_6_10_2","first-page":"e36401","article-title":"Non-stick liver parenchymal transection with saline-linked bipolar clamp-crush technique in robotic liver resection","volume":"15","author":"Kajiwara M","year":"2023","unstructured":"Kajiwara M, Fujikawa T, Naito S, Hasegawa S, Wakasugi J. Non-stick liver parenchymal transection with saline-linked bipolar clamp-crush technique in robotic liver resection. Cureus. 2023;15(3):e36401.","journal-title":"Cureus"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.21037\/hbsn.2015.10.05"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.7602\/jmis.2024.27.2.114"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(99)80227-X"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.21037\/hbsn.2017.01.14"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-025-17225-9"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.70006"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-019-00935-0"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-11005-4"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.166"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11701-021-01286-5"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2007.10.495"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/1553350621991223"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-024-11276-x"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.6901"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.000711"}],"container-title":["Surgical Innovation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15533506261477024","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15533506261477024","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15533506261477024","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T11:51:14Z","timestamp":1786794674000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15533506261477024"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":24,"alternative-id":["10.1177\/15533506261477024"],"URL":"https:\/\/doi.org\/10.1177\/15533506261477024","relation":{},"ISSN":["1553-3506","1553-3514"],"issn-type":[{"value":"1553-3506","type":"print"},{"value":"1553-3514","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"15533506261477024"}}