Kim Ji Hoon, Park Hyeong Min
Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang-si, Korea.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College Medicine, Seoul, Korea.
Ann Surg Oncol. 2025 May;32(5):3501-3504. doi: 10.1245/s10434-024-16841-1. Epub 2025 Jan 6.
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.
对肝脏内部结构的更深入理解改变了解剖性肝切除术，突出了肝段间平面的重要性，该区域缺乏格利森分支。这些见解促成了一种新的手术技术，该技术专注于在吲哚菁绿（ICG）荧光成像和机器人平台的支持下精确分离肝段间平面，提高了肝切除术的精确性和安全性。
本研究纳入了4例使用达芬奇Xi系统接受机器人辅助左半肝切除术的患者。采用肝外格利森入路，随后在ICG引导下勾勒肝段间平面。使用机器人手臂进行实质离断，以实现精确控制并将热损伤降至最低，确保肝段间平面得以保留。
中位手术时间为215分钟，中位失血量为35毫升。这些患者均无需转为开放手术，也未出现术后并发症，且切缘均为阴性。中位住院时间为5.5天。
在ICG成像引导下，机器人辅助分离肝段间平面为解剖性肝切除术提供了一种精确且微创的方法。该技术利用了肝脏的自然解剖特征，改善了患者预后，并在肝脏手术方面取得了重大进展。
