Current status and advances of robotic hepatectomy for difficult liver segments

As a landmark technological breakthrough in 21st-century minimally invasive surgery, robotic surgical systems have been widely adopted for all types of hepatectomy. Difficult liver segments, including Couinaud segments I, IVa, VII and VIII, occupy deep anatomical spaces in immediate proximity to the hepatic veins and inferior vena cava. Conventional laparoscopic techniques suffer from limited working space and suboptimal surgical visualization, thereby substantially raising technical challenges and perioperative risks. Equipped with exclusive merits such as high-definition three-dimensional stereoscopic vision, multi-articulated bionic manipulators and sustained stable field retraction, robotic platforms effectively overcome the inherent limitations of conventional laparoscopy and deliver an innovative technical paradigm for minimally invasive resection of anatomically demanding hepatic segments. In the present study, we summarize the overall application status of robotic hepatectomy. Focusing on the definition and surgical hurdles of difficult hepatic segments, it integrates our institutional clinical experience with data from domestic and international comparative studies to objectively elaborate the core strengths and intrinsic limitations of robotic resection for these lesions. Furthermore, we delineate cutting-edge advances including robotic-specific difficulty scoring metrics, single-port robotic systems, remote robotic surgery and AI-assisted intraoperative navigation, in order to provide theoretical support and clinical references for standardized minimally invasive resection of anatomically intricate complex hepatic segments.