Throughout the development of liver surgery, miniaturization and precision have become inevitable trends. Robotic-assisted liver resection has been clinically validated over many years, and its safety and feasibility are widely recognized in the field. The release of the 2023 International Expert Consensus on Robotic Liver Resection has further standardized the approach. Single-port robotic surgical systems combine the precision of robotic operation with the minimally invasive advantages of single-port surgery, and have been successfully applied across various surgical fields. However, research on the application of domestic single-port robots in precise resection of complex liver segments remains very limited.

This study is based on a real clinical case at Peking University Shougang Hospital, exploring the clinical value of the SHURUI Single-Port Robotic Surgical System (SPRS)—i.e., the SHURUI Thoracolaparoscopic Single-Port Surgical System—in liver resection. It systematically describes the technical advantages, innovative features, potential application limitations, optimization strategies, and surgical indications of the SHURUI system. This report is the first clinical documentation of a domestic device achieving R0 resection of the S4b+S5v liver segments, filling a gap in the application of this technique for this procedure and providing important clinical evidence for the domestic adoption and standardized development of single-port robotic minimally invasive liver surgery.

This case report was published in iLIVER, a liver-specialty journal under Elsevier, Volume 5 (2026), Issue 100223, by the Hepatobiliary and Pancreatic Center team at Peking University Shougang Hospital. The study involved a 63-year-old patient with hepatocellular carcinoma (HCC) complicated by hepatitis B, cirrhosis, and diabetes. The patient first received transcatheter arterial chemoembolization (TACE) combined with targeted immunotherapy as neoadjuvant therapy. After achieving partial remission of the tumor, the patient underwent SHURUI single-port robot-assisted S4b+S5v liver segmentectomy. The study comprehensively reports perioperative indicators, postoperative recovery, pathological findings, and short-term follow-up results, systematically evaluating the key dimensions of the SHURUI system in comparison with traditional and internationally standard minimally invasive liver resection techniques.

The study included a 63-year-old male HCC patient who received SHURUI single-port robot-assisted S4b+S5v liver segmentectomy after tumor shrinkage from neoadjuvant therapy. Through standardized perioperative management and postoperative follow-up, reliable clinical outcomes were achieved, as detailed below:

1. Stable surgical indicators, significant minimally invasive advantages:

The procedure utilized a single 4 cm midline incision in the periumbilical region, serving both for surgical manipulation and specimen extraction. A drain was placed through an auxiliary port, requiring no additional incisions compared to traditional multi-port (5-port) approaches. Intraoperative blood loss was 200 mL, with a total operative time of 240 minutes. These core surgical metrics were comparable to historical data from multi-port robotic and laparoscopic liver resections at the same institution.

2. Rapid postoperative recovery, no surgical complications:

The patient resumed oral intake gradually, was able to ambulate on the first postoperative day, the drain was removed on postoperative day 3, and the patient was successfully discharged on postoperative day 7. No postoperative complications occurred throughout the entire course, indicating favorable perioperative safety.

3. Excellent pathological radical resection outcome, good short-term prognosis:

Postoperative pathology revealed 95% tumor necrosis, with the remaining portion being moderately differentiated, no microvascular invasion, an intact tumor capsule, negative resection margins, and associated cirrhosis—achieving R0 radical resection. Six-month follow-up showed no tumor recurrence.

Key findings from the study:

1. Demonstrated the feasibility, safety, and efficacy of domestic single-port robots in liver resection.

2. Showed advantages of the SPRS in reducing incisions, shortening docking time, improving anatomical precision, and enhancing suturing smoothness.

3. Proposed preliminary indications for SPRS liver resection (tumor ≤5 cm, located in segments S2, S3, S4, S5, S6, without extensive vascular invasion), with particular recommendation for patients prioritizing rapid recovery and cosmetic outcomes.

Quoted original statements from the paper:

"Compared with traditional laparoscopy, the SPRS surgical arm can achieve 120° all-round free movement, highly simulating the flexibility of human hands and avoiding the 'chopstick effect' of single-port laparoscopic instruments."

"This advantage is particularly prominent during preset hepatic hilum blockade—the bendable surgical arm can attempt to pass through the posterior space of the hepatic hilum from multiple angles."

"The reported average docking time of the da Vinci surgical system is 7 to 10 minutes, while the docking time in this study was only 5 minutes. In addition, the one-click lens cleaning function, an innovation of the SHURUI SPRS, can also save operation time and improve efficiency."

"Only one vascular suture was performed throughout the operation, and the experience and fluency of the suture operation were significantly better than those of laparoscopy."

Academic value: This study provides the first detailed case evidence of a domestic single-port robot performing precise liver resection, enriching the surgical repertoire of single-port robotic liver resections. By comparing with historical data from multi-port robots and laparoscopic procedures, it objectively demonstrates relative advantages in incision cosmesis, docking time, and maneuverability in narrow spaces.

Surgical innovation breakthrough: This study achieved the first S4b+S5v combined liver resection using the SHURUI SPRS (i.e., SHURUI thoracolaparoscopic single-port surgical system), verifying the technical feasibility of single-port robots in treating liver tumors. The innovative use of a single 4 cm periumbilical incision as both the operating port and specimen extraction channel achieved the minimally invasive goal of "no additional incisions." Furthermore, the use of a bendable robotic arm to pass through the posterior hilar space from multiple angles provides a new operative demonstration for hilar pre-blockade via the single-port approach.

Conclusion: This study confirms that the domestic SHURUI thoracolaparoscopic single-port surgical system has achieved multiple technical breakthroughs, effectively enhancing the clinical feasibility of single-port robotic minimally invasive liver resection. Compared to traditional laparoscopy and multi-port robotic surgery, this device demonstrates outstanding advantages in miniaturization, flexibility, and surgical efficiency, allowing safe R0 radical resection of complex liver segments with reliable prognosis and excellent cosmetic outcomes. It represents a reliable minimally invasive option for liver resection.

With continued iteration and upgrading of specialized instruments and accumulating clinical experience among surgeons, the SHURUI thoracolaparoscopic single-port surgical system is expected to further expand the clinical application scenarios in liver surgery, continuously advancing the high-quality development of domestic minimally invasive surgical equipment and precision liver surgery technology.