Robotic Right Anterior Sectionectomy Using the Extrahepatic Glissonean Approach and ICG-Guided Hepatectomy (with Video).

Background: 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.

Materials And Methods: The procedure was performed using the Da Vinci Xi system with a four-arm configuration.

Results: 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.

Conclusions: 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.