What question did this study set out to answer?

This study aims to identify the risk factors contributing to significant intraoperative blood loss during robotic liver resection and assess its clinical outcomes.

March 26, 2026Open Access

When the robot bleeds: risk factors and outcomes of intraoperative blood loss in robotic liver resection

Puntos clave

This study aims to identify the risk factors contributing to significant intraoperative blood loss during robotic liver resection and assess its clinical outcomes.
Retrospective analysis of 708 robotic liver resections across nine European centers from 2011 to 2023.
Patients stratified into two groups based on intraoperative blood loss (< 500 mL and ≥ 500 mL).
Demographic, intraoperative, and postoperative data were collected from a shared database.
Univariable analysis was conducted, followed by multivariate logistic regression for significant variables.
Mean intraoperative blood loss was 224.7 mL; 9.6% of patients experienced blood loss ≥ 500 mL.
Cirrhosis and higher TAMPA score were independent predictors of major bleeding.
Patients with ≥ 500 mL IBL had significantly longer operative times (372 min vs. 239 min).
Higher morbidity rates were noted in the ≥ 500 mL group (72% vs. 46%).
Mortality was greater in the high blood loss group (4.4% vs. 0.6%).

Resumen

Despite the advantages of robotic-assisted liver resection (RALR), intraoperative blood loss (IBL) remains a main concern in hepatic surgery. The current multicenter study was designed to evaluate the determinants of significant intraoperative bleeding in RALR and the clinical impact of such bleeding. This study retrospectively analyzed 708 consecutive RALR performed in nine high-volume European centers between 2011 and 2023. All demographic, intraoperative, and postoperative data were extracted from a shared database. Patients were stratified into two groups based on the IBL value (< 500 mL vs. ≥ 500 mL). Variables that reached the level of p < 0.10 at univariable analysis were included in a multivariate logistic regression model. The mean IBL was 224.7 mL, and 9.6% of patients experienced IBL ≥ 500 mL. Both cirrhosis (OR 3.00, 95% CI 1.63–5.52; p < 0.001) and higher TAMPA score (OR 1.09 per point, 95% CI 1.03–1.16; p = 0.004) independently predicted major bleeding. Patients with IBL ≥ 500 mL had longer operative times (372 vs. 239 min, p < 0.001), higher morbidity (72% vs. 46%, p < 0.001), and greater mortality (4.4% vs. 0.6%, p = 0.022). During RALR significant bleeding persists in 10% of cases. Cirrhosis and procedural complexity remain independent predictors. Early identification of the high-risk patient and tailored perioperative strategies are of paramount importance in reducing bleeding and improving overall outcomes following robotic hepatobiliary surgery.

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