*8.3.2 Non-anatomical robotic liver resection*

In our experience the Pringle manoeuvre has to be rarely used for NARs but when there is a need to secure more control on the liver inflow, the hepatic pedicle is prepared and a tourniquet is created using an umbilical tape. NARs are generally reserved for liver lesions that are superficial, subcapsular or easily visualised. As discussed above the main tool used for parenchymal transection is the robotic harmonic scalpel and it is ideally suited to perform NARs. Prior to commencing transection the resection line can be marked with diathermy which also allows the robotic harmonic scalpel to be positioned correctly and may mandate the switching of the robotic harmonic scalpel between different robotic arms. As described above transection is recommended to be performed in a layer-by-layer fashion. The fourth robotic arm can be used to aid retraction such that there is minimal traction on the lesion itself. Once the resection is completed haemostasis is achieved with a combination of the robotic energy instruments and topical haemostatic agents.
