Pencil cleaning technique for robotic liver parenchymal transection : a step further to systematization beyond the microfracture-coagulation method
Navinés i López, Jordi (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Pardo Aranda, Fernando (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Cremades, Manel (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Zárate Pinedo, Alba (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Sentí Farrarons, Sara. (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Lucas Guerrero, Victoria (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Espin Alvarez, Francisco (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Cugat Andorrà, Esteban (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)

Data:	2025
Resum:	Robotic liver resections based on Laennec's capsule pedicular driven dissection is a challenging surgical procedure, because of the intrinsic relationship between the liver parenchyma and the main intrahepatic vessels. The absence of anatomical landmarks and the frailty of the fine vascular structures requires broad experience, anatomical knowledge and refined technical skills to successfully perform such a procedure. As robotic platforms do no offer the standard laparoscopic advanced tools for liver resection, real robotic approach has been proposed as a default technique for the liver parenchymal transection, precise robotic anatomical and parenchymal-sparing liver resection, and pedicle driven dissection, like the microfracture-coagulation method. A more specific refinement of the real robotic approach, similar to the pencil cleaning process, useful in very careful deep dissections, is defined towards the standardization of the real robotic approach in advanced liver surgery. The rationale of the method, its indications and tips and tricks are described in detail.
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Liver surgery ; Real robotic approach ; Robotic liver surgery ; Pedicle driven approach ; Liver parenchymal transection ; Microfracture-coagulation ; Pencil cleaning
Publicat a:	Journal of robotic surgery, Vol. 19 Núm. 1 (December 2025) , p. 399, ISSN 1863-2491

DOI: 10.1007/s11701-025-02480-5
PMID: 40676320

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