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Background <p>Minimally invasive liver surgery offers a caudal “look-up” view that may facilitate caudate lobe resection.<sup><CitationRef CitationID="CR1">1</CitationRef>,<CitationRef CitationID="CR2">2</CitationRef></sup> In this video, we demonstrate a robotic total caudate lobectomy (high dorsal resection) using an Arantius-ligament hanging maneuver, indocyanine green (ICG) negative staining, and intraoperative ultrasound (IOUS).</p> Case Description <p>A 79-year-old woman with mid-rectal adenocarcinoma developed a solitary caudate lobe metastasis. She received neoadjuvant FOLFOX (4 cycles) and experienced an ischemic stroke with full neurologic recovery. After multidisciplinary review and medical optimization, curative-intent local therapy was recommended. We performed a robotic total caudate lobectomy (Spiegel lobe, paracaval portion, and caudate process) with Arantius-ligament hanging, IOUS guidance, and ICG negative staining. Operative time was 316 minutes; estimated blood loss was 200 mL. Intermittent Pringle occlusion totaled 55 minutes. Length of stay was 5 days. Final pathology demonstrated metastatic colorectal adenocarcinoma (3 cm) with an R0 resection (closest margin &lt;1 mm).</p> Conclusions <p>Robotic high dorsal resection is feasible in selected patients. Combining Arantius-ligament hanging with IOUS and ICG negative staining provides stable exposure along the retrohepatic inferior vena cava and objective segmental delineation to support a margin-oriented segment I resection.</p>

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Robotic Caudate Lobectomy for a Solitary Colorectal Liver Metastasis Using Arantius‑Ligament Hanging and ICG Negative Staining

  • 期刊论文

  • 发表日期：

    2026年3月5日

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  • Samia Ellias,
  • Andrew B. Crocker,
  • Rishi Jonnala,
  • Belen Rivera,
  • Omid Salehi,
  • John Friel,
  • Olga Kozyreva,
  • Eduardo A. Vega

摘要

Background

Minimally invasive liver surgery offers a caudal “look-up” view that may facilitate caudate lobe resection.1,2 In this video, we demonstrate a robotic total caudate lobectomy (high dorsal resection) using an Arantius-ligament hanging maneuver, indocyanine green (ICG) negative staining, and intraoperative ultrasound (IOUS).

Case Description

A 79-year-old woman with mid-rectal adenocarcinoma developed a solitary caudate lobe metastasis. She received neoadjuvant FOLFOX (4 cycles) and experienced an ischemic stroke with full neurologic recovery. After multidisciplinary review and medical optimization, curative-intent local therapy was recommended. We performed a robotic total caudate lobectomy (Spiegel lobe, paracaval portion, and caudate process) with Arantius-ligament hanging, IOUS guidance, and ICG negative staining. Operative time was 316 minutes; estimated blood loss was 200 mL. Intermittent Pringle occlusion totaled 55 minutes. Length of stay was 5 days. Final pathology demonstrated metastatic colorectal adenocarcinoma (3 cm) with an R0 resection (closest margin <1 mm).

Conclusions

Robotic high dorsal resection is feasible in selected patients. Combining Arantius-ligament hanging with IOUS and ICG negative staining provides stable exposure along the retrohepatic inferior vena cava and objective segmental delineation to support a margin-oriented segment I resection.