Detachment of the Intersegmental Plane in Robotic Left Hepatectomy Using Indocyanine Green Fluorescent Imaging (with Video).

Abstract

Anatomical liver resection has been altered by a deeper understanding of the internal structure of the liver, highlighting the importance of the intersegmental plane, a region lacking Glissonean branches. These insights have enabled a novel surgical technique focused on the precise detachment of the intersegmental plane, supported by indocyanine green (ICG) fluorescent imaging and robotic platforms, enhancing the precision and safety of liver resection. This study involved four patients who underwent robotic left hepatectomy using the Da Vinci Xi system. The extrahepatic Glissonean approach was applied, followed by ICG-guided delineation of the intersegmental plane. Parenchymal transection was performed using robotic arms for precise control and minimal thermal damage, ensuring the preservation of the intersegmental plane. The median operation time was 215 min, with a median blood loss of 35 mL. None of these patients required conversion to open surgery or had postoperative complications, and all had negative resection margins. The median hospital stay was 5.5 days. Robotic-assisted detachment of the intersegmental plane, guided by ICG imaging, offers a precise and minimally invasive approach for anatomical liver resection. This technique leverages the natural anatomical features of the liver, improving patient outcomes and providing a significant advance in liver surgery.