Wakabayashi Taiga, Ken Jonathan Seak Chen, Nie Yusuke, Teshigahara Yu, Gasque Rodrigo Antonio, Igarashi Kazuharu, Wakabayashi Go
Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan.
Ann Surg Oncol. 2025 Aug;32(8):5710. doi: 10.1245/s10434-025-17445-z. Epub 2025 May 19.
Anatomical liver resection benefits from controlling Glissonean pedicles before parenchymal transection to ensure accurate anatomical boundaries. In segment 8, high-branching Glissonean anatomy can hinder identification of the targeted pedicle, increasing the risk of misidentification. A hilum-first, stepwise intrahepatic approach facilitates safe and precise isolation of each ramification. We present a case of robotic S8 segmentectomy for hepatocellular carcinoma (HCC), using a strategy adapted to this anatomical variation.
An 83-year-old male with HCC in S8 underwent robotic segmentectomy. Preoperative imaging revealed high-branching of G5 from G8 branches. The anterior Glissonean pedicle was first encircled. (1) G5d + G8d and (2) G5v were isolated, enabling identification of G8v and G8d by subtraction. These branches were selectively clamped, and ICG-negative staining guided precise anatomical resection. The robotic system's enhanced dexterity and magnified 3D vision enabled atraumatic handling of these fine branches.
This approach allowed more distal pedicle division than initially planned, preserving 104 mL (10%) of functional liver. Blood loss was 10 mL/kg, and no complications occurred. The patient was discharged on postoperative day 6. Pathology confirmed moderately differentiated HCC (T2N0M0, UICC 8th) with negative margins and no microvascular invasion.
Robotic liver resection enables precise and atraumatic intrahepatic Glissonean dissection, particularly in cases with high-branching Glissonean anatomy. A hilum-first, stepwise approach-combined with real-time ICG fluorescence imaging-offers a reliable method for safely isolating targeted pedicles, thereby enhancing oncological precision and preserving functional liver volume in challenging segment 8 resections.
解剖性肝切除受益于在实质离断前控制肝蒂，以确保准确的解剖边界。在肝段8中，肝蒂的高分支解剖结构可能会妨碍对目标肝蒂的识别，增加误认的风险。肝门优先、逐步肝内入路有助于安全、精确地分离每个分支。我们报告一例肝细胞癌（HCC）的机器人辅助肝段8切除术，采用了适应这种解剖变异的策略。
一名83岁男性，肝段8患有HCC，接受了机器人辅助肝段切除术。术前影像学检查显示G5从G8分支高分支。首先环绕肝门前方肝蒂。（1）分离G5d + G8d和（2）G5v，通过减法识别G8v和G8d。这些分支被选择性夹闭，吲哚菁绿（ICG）阴性染色引导精确的解剖性切除。机器人系统增强的灵活性和放大的三维视觉能够对这些细小分支进行无创伤操作。
这种方法允许比最初计划更向远端的肝蒂离断，保留了104 mL（10%）的功能性肝组织。失血为10 mL/kg，未发生并发症。患者术后第6天出院。病理证实为中度分化的HCC（T2N0M0，国际抗癌联盟第8版），切缘阴性，无微血管侵犯。
机器人肝切除术能够实现精确、无创伤的肝内肝蒂解剖，特别是在肝蒂高分支解剖的病例中。肝门优先、逐步入路结合实时ICG荧光成像，为安全分离目标肝蒂提供了一种可靠的方法，从而在具有挑战性的肝段8切除术中提高肿瘤学精确性并保留功能性肝体积。
