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Peer-reviewedCC BY-NCBMJ connections. Surgery

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.

  • Gabriela Pilz da Cunha1,2
  • Hannah H Schulz2,3
  • Tijs J Hoogteijling1,2
  • Maarten Lj Smits4
  • Katrin Stoecklein5
  • Martijn R Meijerink2,3
  • Rutger-Jan Swijnenburg1,2
5 affiliations
  1. 1Department of Surgery, Amsterdam UMC, the University of Amterdam, Amsterdam, The Netherlands.
  2. 2Cancer Center Amsterdam, Amsterdam, The Netherlands.
  3. 3Department of Nuclear Medicine and Radiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
  4. 4Department of Radiology and Nuclear Medicine, UMC Utrecht, Utrecht, The Netherlands.
  5. 5Department of Anaesthesiology, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
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Abstract

Objectives

To perform the first-in-human concomitant robotic liver resection and cone-beam CT (CBCT)-guided ablation in a hybrid operating room (HARMONY).Design

IDEAL 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

All procedures took place at a single academic medical centre.Participants

Patients 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

Concomitant robotic liver resection and CBCT-guided ablation in a hybrid operating room.Main outcome measures

The 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

Between 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

The 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

CCMO Research with human participants (NL-009169).

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Cite

BibTeXRIS
BibTeX
@article{cunha2026staged,
  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.}},
  author = {Gabriela Pilz da Cunha and Hannah H Schulz and Tijs J Hoogteijling and Maarten Lj Smits and Katrin Stoecklein and Martijn R Meijerink and Rutger-Jan Swijnenburg},
  journal = {BMJ connections. Surgery},
  year = {2026},
  month = jul,
  doi = {10.1136/bmjcsurg-2026-000035},
  url = {https://europepmc.org/article/MED/42968890},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - 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.
AU  - Gabriela Pilz da Cunha
AU  - Hannah H Schulz
AU  - Tijs J Hoogteijling
AU  - Maarten Lj Smits
AU  - Katrin Stoecklein
AU  - Martijn R Meijerink
AU  - Rutger-Jan Swijnenburg
PY  - 2026
DA  - 2026/07/02
JO  - BMJ connections. Surgery
DO  - 10.1136/bmjcsurg-2026-000035
UR  - https://europepmc.org/article/MED/42968890
AB  - Objectives  To perform the first-in-human concomitant robotic liver resection and cone-beam CT (CBCT)-guided ablation in a hybrid operating room (HARMONY).Design  IDEAL 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  All procedures took place at a single academic medical centre.Participants  Patients 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  Concomitant robotic liver resection and CBCT-guided ablation in a hybrid operating room.Main outcome measures  The 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  Between 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  The 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  CCMO Research with human participants (NL-009169).
SN  - 2978-1809
ER  -