Sealer and Moisture-Based Approach (SAMBA) Hepatectomy Technique for Robotic Parenchymal Transection

BACKGROUND: Robotic sealing devices, such as SynchroSeal and Vessel Sealer Extend, have shown that parenchymal transection is possible without using laparoscopic instruments Finotti (Hepatobiliary Surg Nutr. 12:56-68, 2023), Palucci (J Robot Surg 19(1):36, 2024), Birgin (Lancet Reg Health Eur 43, 2024). However, there is still a need for detailed procedural guidance to ensure that these techniques can be applied effectively and consistently. METHODS: We describe the Sealer and Moisture-Based Approach (SAMBA) hepatectomy technique a standardized purely robotic approach for hepatic parenchymal transection that combines robotic vessel-sealing tools with targeted saline irrigation. Between February 2021 and October 2024, a total of 72 consecutive robotic hepatectomies were performed using the SAMBA hepatectomy technique at Ulm University Hospital. RESULTS: The Da Vinci Xi-system was used for all hepatectomies. Parenchymal transection was performed with the SynchroSeal in 55 and the Vessel Sealer Extend in 17 cases. Of these, 27 resections were nonanatomical, and 45 resections were anatomical hepatectomies with a median operative time of 174 minutes (interquartile range [IQR] 134-236), and blood loss of 200 mL (IQR 100-400). No cases of posthepatectomy hemorrhage or mortality were observed within 90 days after surgery. CONCLUSIONS: SAMBA hepatectomy technique is an effective method for robotic liver parenchymal transection. Incorporating moisture during sealing improves tissue handling, minimizes carbonization, and enhances visualization. Prospective studies are warranted to compare the SAMBA technique with other techniques of parenchymal transection.