无论采用哪种方法，安全有效的实质横切对于肝切除术至关重要。1在机器人手术中，这可以通过多种方法来完成。作者重点介绍了一些用于横切肝脏的更常见的工具和技术。血管密封器扩展是一种控制台控制的设备，具有双极能量、机械切割、全腕关节和抓握能力，使其能够在密封小血管的同时复制夹压技术。然而，钳口体积较大，对于坚硬/纤维化的肝脏来说不是最佳选择。2,3 Synchroseal 具有血管密封器延伸的许多功能，但钳口更薄，使其更容易在坚硬的肝脏中前进，并且缺少切割刀片，而是依靠用于分割组织的切割电极。蛋白质炭会积聚在钳口上，削弱其有效性，但间歇性灌溉可以缓解这种情况。机器人 Harmonic 手术刀可凝固、横切并精确解剖薄壁组织。然而，它的长度有限，并且缺乏腕关节。4,5 超声波手术抽吸装置可以在血管胆结构周围进行精确、无创伤的解剖，但目前不存在机器人集成版本。因此，在机器人手术中应用该技术需要经验丰富的床边助手操作腹腔镜手术，而控制台外科医生则使用机器人器械来凝固、夹闭和分割较大的结构。6-9 双双极技术对于点凝固和解剖很有用，但横断能力有限。10 它通常是其他横断技术的辅助手段。11-13 存在多种机器人实质横断方法，虽然没有一种方法是完美的，但可以将它们组合起来以实现安全有效的横断。© 2024。外科肿瘤学会。

Regardless of approach, safe and effective parenchymal transection is critical for hepatectomies.1 In robotic surgery, this can be accomplished via several methods. The authors highlight some of the more common tools and techniques used to transect the liver. The Vessel Sealer Extend is a console-controlled device with bipolar energy, mechanical cutting, full-wristed articulation, and grasping abilities that allow it to replicate the clamp-crush technique while sealing small vessels. However, the jaw is bulky and suboptimal for firm/fibrotic livers.2,3 The Synchroseal shares many features of the Vessel Sealer Extend but has thinner jaws, making it easier to advance in firm livers, and lacks a cutting blade, relying instead on a cut electrode to divide tissue. Proteinaceous char can accumulate on the jaws, impairing its effectiveness, but intermittent irrigation can mitigate this. The robotic Harmonic Scalpel coagulates, transects, and precisely dissects parenchyma. However, it is limited in length and lacks wristed articulation.4,5 Ultrasonic surgical aspiratory devices allow for precise, atraumatic dissection around vasculobiliary structures, but no robotic-integrated versions currently exist. Therefore, application of this technology in robotic surgery requires an experienced bedside assistant operating the laparoscopic version while the console surgeon uses robotic instruments to coagulate, clip, and divide larger structures.6-9 The dual bipolar technique is useful for spot coagulation and dissection but has limited transection ability.10 It often is an adjunct to other transection techniques.11-13 Several methods exist for robotic parenchymal transection, and although none are perfect, they can be combined for safe and effective transection.© 2024. Society of Surgical Oncology.