Kim Ji Hoon, Park Hyeong Min, Na Byeng-Gon
Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, 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 Jul 27. doi: 10.1245/s10434-025-17909-2.
Minimally invasive liver surgery, including robotic liver resection, has evolved to enable complex procedures such as right anterior sectionectomy. The extrahepatic Glissonean approach, combined with indocyanine green (ICG) fluorescence imaging, enhances precision during anatomical liver resection. This study presents my experience of robotic right anterior sectionectomy, focusing on surgical technique and outcomes.
The procedure was performed using the Da Vinci Xi system with a four-arm configuration.
The robotic platform's 3D vision, magnification, and EndoWrist function allow precise dissection of the extrahepatic Glissonean pedicle, improving safety and efficiency, particularly in narrow spaces such as the liver hilum. Right anterior sectionectomy involves two wide parenchymal transections: the midplane and the curved right intersegmental plane. ICG-guided hepatectomy ensures accurate identification of the intersegmental boundary, facilitating precise anatomical resection.
The robotic system enhances dexterity and visualization, allowing meticulous extrahepatic Glissonean dissection and ICG-guided transection. This approach minimizes remnant ischemia and bile leakage while improving surgical precision. Robotic right anterior sectionectomy represents a major advancement in minimally invasive liver surgery, offering improved safety and outcomes because of its enhanced precision.
包括机器人肝脏切除术在内的微创肝脏手术已经发展到能够进行诸如右前叶切除术等复杂手术。肝外Glissonean入路结合吲哚菁绿（ICG）荧光成像，可提高解剖性肝脏切除术中的精准度。本研究介绍了我在机器人右前叶切除术方面的经验，重点关注手术技术和结果。
使用具有四臂配置的达芬奇Xi系统进行该手术。
机器人平台的三维视觉、放大功能和EndoWrist功能可精确解剖肝外Glissonean蒂，提高安全性和效率，尤其是在肝门等狭窄空间。右前叶切除术涉及两个较宽的实质横断：中平面和弯曲的右段间平面。ICG引导的肝切除术可确保准确识别段间边界，便于精确的解剖性切除。
机器人系统提高了灵活性和可视化程度，允许进行细致的肝外Glissonean解剖和ICG引导的横断。这种方法可将残余缺血和胆漏降至最低，同时提高手术精准度。机器人右前叶切除术代表了微创肝脏手术的一项重大进展，因其提高了精准度而具有更高的安全性和更好的结果。
