{
  "abstract": "Objectives\n\nTo perform the first-in-human concomitant robotic liver resection and cone-beam CT (CBCT)-guided ablation in a hybrid operating room (HARMONY).Design\n\nIDEAL stage 0/1 study outlining the preparatory steps and outcomes of the first-in-human HARMONY procedure. IDEAL stage 0 involved conceptualisation, team training and dry runs. The first HARMONY procedure was performed and the procedural technique is described in detail.Setting\n\nAll procedures took place at a single academic medical centre.Participants\n\nPatients eligible for the HARMONY procedure are any adults eligible for combined ablation and resection of colorectal liver metastases. The HARMONY procedure was performed in a first patient. Outcomes of patients who underwent sequential robotic liver resection and CT hepatic arteriography-guided liver ablation in the preparatory phase are also reported.Intervention\n\nConcomitant robotic liver resection and CBCT-guided ablation in a hybrid operating room.Main outcome measures\n\nThe primary outcome was technical feasibility of the HARMONY procedure defined as the technical success of both the robotic surgical resection and CBCT-guided ablation within the hybrid operating room.Results\n\nBetween 2018 and 2024, 19 patients underwent sequential robotic liver resection and CT-guided ablation. Median interval between procedures was 4 days, with 36.8% treated during one admission. Intraoperative incidents occurred in three (15.8%) patients and two (10.5%) patients experienced severe complications requiring reintervention. The first-in-human HARMONY procedure was successfully completed without intraoperative complications.Conclusions\n\nThe concomitant performance of robotic liver resection and CBCT-guided ablation is technically feasible in a hybrid operating room. Future studies should evaluate its reproducibility, safety and long-term outcomes.Trial registration number\n\nCCMO Research with human participants (NL-009169).",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, Amsterdam UMC, the University of Amterdam, Amsterdam, The Netherlands.",
    "Cancer Center Amsterdam, Amsterdam, The Netherlands.",
    "Department of Nuclear Medicine and Radiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands.",
    "Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands.",
    "Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Gabriela Pilz da Cunha",
      "orcid": "0000-0001-9055-1049"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Hannah H Schulz"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Tijs J Hoogteijling"
    },
    {
      "affs": [
        3
      ],
      "name": "Maarten Lj Smits"
    },
    {
      "affs": [
        4
      ],
      "name": "Katrin Stoecklein"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Martijn R Meijerink"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Rutger-Jan Swijnenburg"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/f1msd29kky12z.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjcsurg-2026-000035",
  "fulltext_url": "https://europepmc.org/articles/PMC13723784",
  "id": "f1msd29kky12z",
  "issns": [
    "2978-1809"
  ],
  "landing_url": "https://europepmc.org/article/MED/42968890",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2721|Hepatocellular Carcinoma Treatment and Prognosis"
    ]
  ],
  "openalex": "W7167053936",
  "pdf_url": "https://europepmc.org/articles/PMC13723784?pdf=render",
  "pmcid": "PMC13723784",
  "pmid": "42968890",
  "published": "2026-07-02",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/f1msd29kky12z.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:54Z",
      "native_id": "MED:42968890",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42968890"
    },
    {
      "first_seen": "2026-11-04T12:22:21Z",
      "native_id": "PMC13723784",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjcsurg-2026-000035"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2721|Hepatocellular Carcinoma Treatment and Prognosis",
      "subfield": "general"
    }
  ],
  "title": "Staged introduction of a first-in-human concomitant robotic liver resection and cone-beam CT-guided percutaneous liver ablation in a hybrid operating room (HARMONY): an IDEAL stage 0/1 study.",
  "title_text": "Staged introduction of a first-in-human concomitant robotic liver resection and cone-beam CT-guided percutaneous liver ablation in a hybrid operating room (HARMONY): an IDEAL stage 0/1 study.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:32Z",
  "url": "https://research.draconitic.com/paper/f1msd29kky12z",
  "venue": "BMJ connections. Surgery",
  "versions": []
}