Kim Ji Hoon
Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Ilsandonggu, Goyang-si, Gyeonggi-do, Korea.
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College Medicine, Songpa-gu, Seoul, Korea.
Ann Surg Oncol. 2025 Sep;32(9):6329-6333. doi: 10.1245/s10434-025-17568-3. Epub 2025 Jun 4.
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.
机器人辅助肝手术拓宽了微创肝切除术的可能性。然而，由于其位置深且解剖结构复杂，肝段8的手术存在挑战。经裂Glissonean入路结合机器人辅助和吲哚菁绿（ICG）荧光成像，为实现精确切除提供了一种有前景的方法。
采用经裂Glissonean入路对肝段8腹侧区域进行机器人解剖性切除。解剖并夹闭右前Glissonean蒂，然后沿主门静脉裂小心进行实质切开。使用吲哚菁绿荧光成像精确勾勒肝段间边界，确保准确切除。
手术持续200分钟，失血70毫升，无需术中输血。Pringle手法实施了45分钟。肝细胞癌大小为3.3厘米，切缘为1.1厘米。无并发症发生，术后住院时间为4天。
采用经裂Glissonean入路和ICG荧光对肝段8腹侧区域进行机器人解剖性切除可显著提高手术精度。EndoWrist功能提供的增强灵活性与三维放大相结合，可能有助于更高效的解剖，并有可能减少并发症，从而改善患者预后。
