Robotic Real Anatomical Right Hepatectomy Preserving the Caudate Lobe: Separate Dissection of the Right Anterior and Posterior Glissonean Pedicles, Combined with the Use of ICG Fluorescent Imaging (with Video)

Conventional right hepatectomy typically involves resection of the right hemiliver, often including partial removal of the caudate lobe. However, recent advancements, particularly in indocyanine green (ICG) fluorescence imaging, have allowed for more accurate identification of anatomical boundaries between liver segments. In this context, we present a refined technique for real anatomical right hepatectomy that preserves the caudate lobe, offering enhanced surgical precision and several distinct advantages over traditional methods.

This study involved a right hepatectomy using the Da Vinci Xi robotic system, employing ICG fluorescence imaging for parenchymal transection. Key steps included the dissection of the right anterior and posterior Glissonean pedicles and the preservation of the caudate lobe. ICG was administered to visualize the boundary between the caudate lobe and the right liver, guiding a precise resection.

The procedure lasted 320 min with 150 mL blood loss. Pathology showed a 6.7 cm × 5.5 cm hepatocellular carcinoma with a 2.1 cm margin. No bile leakage or significant complications occurred, and the patient was discharged on day 6 without issues.

This technique, underpinned by a deep understanding of liver anatomy, the Glissonean approach, and advanced ICG fluorescence imaging, allows for greater precision in defining anatomical boundaries and preserving the caudate lobe. We propose that real anatomical right hepatectomy offers a promising alternative for surgical practice, with the potential for improved outcomes in patients with liver malignancies.