# Microporous Polysaccharide Hemosphere Absorbable Hemostat Combined With a Spray-Type Adhesion Barrier Enhances the Safety and Efficacy of Repeat Robotic Liver Resection: Initial Experience and Outcomes

## TL;DR

Combining a specific hemostat and adhesion barrier during liver surgery may reduce adhesion severity and improve safety for repeat robotic liver resections.

## Contribution

The study is the first to evaluate the combined use of microporous polysaccharide hemosphere and spray-type adhesion barrier in repeat robotic liver resections.

## Key findings

- The combination of MPH and SAB significantly reduced adhesion severity compared to using SAB alone or not at all.
- Robotic adhesiolysis time was significantly shorter in the MPH+SAB group compared to the other groups.
- No increased risk of complications like abscess or bile leakage was observed with the combined use of MPH and SAB.

## Abstract

Background

The use of spray-type adhesion barrier (SAB) can reduce the adhesion formation after liver resection, and some types of absorbable hemostats are reported to have anti-adhesive properties. The safety of repeat hepatectomy remains unknown when microporous polysaccharide hemosphere (MPH) is used in combination with SAB during a previous hepatectomy.

Methods

This single-center retrospective study included a total of 47 consecutive cases that underwent robotic repeat hepatectomy (RRH) at our institution between September 2021 and October 2025. The included patients were divided into three groups: patients who underwent a previous hepatectomy without the use of SAB (non-SAB group, n=15), those with the previous use of SAB only (SAB group, n=21), and those with the previous use of both MPH and SAB (MPH+SAB group, n=11). The perioperative outcomes were compared between the groups.

Results

There were no differences between the groups in background characteristics, difficulty scores, intraoperative blood loss, console time, operative time, or the occurrence of postoperative complications. In the whole cohort, there was no conversion to open hepatectomy and no mortality. While no significant difference was observed between the groups for the duration of adhesiolysis prior to robotic intervention, there were significant differences between the non-SAB, SAB, and MPH+SAB groups in the adhesion severity score (7 vs 6 vs 3, p < 0.001) and the time for robotic adhesiolysis (97.4 min vs. 42.4 min vs. 32.6 min, p = 0.002). The post-hoc pairwise comparison showed that the adhesion severity was less severe in the MPH+SAB group than in the non-SAB group (p < 0.001) or SAB group (p = 0.026).

Conclusions

The combined use of MPH and SAB does not appear to correlate with a higher incidence of intraperitoneal abscess or bile leakage during RRH. Furthermore, their use in a prior hepatectomy may enhance the safety of subsequent RRH by reducing the adhesion severity around the liver. Their application may also help minimize the duration of robotic adhesiolysis surrounding the liver, especially around the previous liver cut surface. Thus, the combined use of MPH and SAB appears feasible and may not be associated with increased complications, but a larger prospective validation is warranted to produce more trustworthy recommendations.