Robotic-Assisted Anatomical Caudate Lobe Resection with Glissonean Pedicle Approach. A Step-by-Step Surgical Technique (with Video).

Abstract

Minimally invasive surgery (MIS) has transformed hepatobiliary procedures, providing significant advantages over traditional open techniques. However, challenges remain, especially in major hepatectomies and posterior segment resections due to the inherent limitations of laparoscopy. The caudate lobe (segment I), located deep within the liver and adjacent to critical vascular structures, presents unique technical difficulties, making it one of the most challenging segments to access laparoscopically. Robot-assisted surgery has emerged as a promising alternative, offering enhanced precision and control, allowing for more precise suturing and ligation of retrohepatic vessels and bile ducts. While there are still hurdles related to liver mobilization and hemostasis, these can be effectively managed through careful preoperative planning and intraoperative techniques, such as three-dimensional (3D) reconstructions and counterstaining with indocyanine green, which improve the safety and efficacy of anatomical caudate lobe resections. Therefore, this study aims to explore the safety and feasibility of robot-assisted complete caudectomy, detailing the technical aspects step-by-step through a case video example of an anatomical resection for hepatocarcinoma with Glissonean pedicle access.