Clin Transplant Res.  2024 Mar;38(1):7-12. 10.4285/kjt.23.0059.

Surgical techniques for robotic right donor hepatectomy, part 1: robotic hilar dissection and right lobe mobilization

• Cheah YL
• Simon CJ

• KMID: 2555991
• DOI: http://doi.org/10.4285/kjt.23.0059

Abstract

Robotic surgery is emerging as a feasible minimally invasive approach for donor hepatectomy at specialized centers. The aim of this article is to systematically describe the surgical techniques for robotic hilar dissection and right lobe mobilization in right donor hepatectomy. The setup of the robotic arms, the dissection of inflow vessels and retrohepatic inferior vena cava, and the pearls and pitfalls of these two parts of the operation are detailed.

Keyword

Robot surgery; Living donor; Hepatectomy

Figure

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  Fig. 1 Port placement (blue, robotic; green, laparoscopic assistant ports) for right donor hepatectomy.

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  Fig. 2 Usage of the third arm with a gauze as a pulley to retract the ligature placed at the cystic duct stump, which will rotate the common bile duct and common hepatic duct anteriorly and towards the patient’s left, in order to expose the area posterior to the duct where the right hepatic artery courses.

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  Fig. 3 Standard right hepatic artery coursing posterior to the common hepatic duct encircled with a vessel loop.

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  Fig. 4 Replaced right hepatic artery from the superior mesenteric vein, coursing along the lateral-posterior aspect of the common bile duct and common hepatic duct.

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  Fig. 5 Approaching the right portal vein; the anterior aspect of the portal vein bifurcation is exposed by retracting the replaced right hepatic artery toward the patient’s right.

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  Fig. 6 Caudate branch on the posterior wall of the right portal vein encircled using a large needle driver and Maryland forceps.

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  Fig. 7 After clamping of the right hepatic artery and right portal vein at the hilum, demarcation of the right versus left lobes is enhanced by indocyanine green injection on the Firefly (Intuitive Surgical) view.

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  Fig. 8 Retrohepatic inferior vena cava dissection with division of short hepatic vein branches between clips.

Reference

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