Safety and Feasibility of Microporous Polysaccharide Hemosphere Absorbable Hemostat in Robotic Liver Resection: A Single-Center Retrospective Cohort Study

BACKGROUND: Numerous absorbable hemostats are often employed in liver surgery; however, the safety and efficacy of microporous polysaccharide hemosphere (MPH) absorbable hemostats in robotic liver resection (RLR) remain uncertain. METHODS: This study included 141 cases that underwent RLR at Kokura Memorial Hospital between September 2021 and May 2025. The included patients were divided into three groups: those without using any hemostat (non-hemostat (non-HS) group, n=47), those with the use of fibrin sealant patch (FSP) hemostat (TachoSil®; CSL Behring K.K., Tokyo, Japan) (FSP group, n=23), and those with the use of MPH hemostat (Arista™ AH Absorbable Hemostat; Becton, Dickinson and Company, Franklin Lakes, USA) (MPH group, n=71). The background characteristics and perioperative outcomes were compared between the groups. RESULTS: There were no differences in any background characteristics. The rate of anatomical hepatectomy in the FSP group was higher than in the MPH or non-HS groups (95.7% vs. 35.2% vs. 36.2%, p<0.001), and surgical blood loss was less in the MPH and non-HS groups than in the FSP group (11 mL vs. 0 mL vs. 34 mL, p<0.001). There were no conversions to open hepatectomy in the MPH group, no serious postoperative complications such as hemorrhage or bile leakage, and no mortality. There were no differences in the time for MPH application between the anterolateral and posterosuperior segment areas (35 sec vs. 36 sec, p=0.396), but a significant difference was observed between FSP and MPH application time in anatomical hepatectomy (382 sec vs. 36 sec, p<0.001). CONCLUSIONS: Application of MPH is easy and effective for hemostasis without increasing the rate of bleeding complications after RLR. In addition, MPH may not raise the risk of bile leakage or intra-abdominal abscess. Thus, the use of MPH for RLR appears to be safe, effective, and time-efficient.