Robotic Anatomical Resection of the Liver Segment 8 Ventral Area Using the Transfissural Glissonean Approach and ICG Fluorescent Imaging (Video).

Abstract

Robotic-assisted liver surgery has broadened the possibilities for minimally invasive liver resections. However, segment 8 presents challenges owing to its deep location and intricate anatomy. The transfissural Glissonean approach, in combination with robotic assistance and indocyanine green (ICG) fluorescent imaging, provides a promising method to achieve precise resection. Robotic anatomical resection of the ventral area of segment 8 was performed by using the transfissural Glissonean approach. The right anterior Glissonean pedicle was dissected and clamped, followed by careful parenchymal transection along the main portal fissure. Indocyanine green fluorescent imaging was employed to precisely delineate the intersegmental boundaries, ensuring accurate resection. The operation lasted 200 min with blood loss of 70 mL, and intraoperative transfusion was not required. The Pringle maneuver was performed for 45 min. The hepatocellular carcinoma was 3.3 cm in size with a 1.1-cm margin. There were no complications, and the postoperative hospital stay was 4 days. Robotic anatomical resection of the segment 8 ventral area using the transfissural Glissonean approach and ICG fluorescence significantly enhances surgical precision. The enhanced dexterity afforded by the EndoWrist function, combined with three-dimensional magnification, may facilitate more efficient dissection and potentially contribute to a reduction in complications, thereby supporting improved patient outcomes.