Clin Transplant Res.  2024 Mar;38(1):13-17. 10.4285/kjt.23.0060.

Surgical techniques for robotic right donor hepatectomy, part 2: robotic parenchymal transection and bile duct division

• Cheah YL
• Simon CJ

• KMID: 2555992
• DOI: http://doi.org/10.4285/kjt.23.0060

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 parenchymal transection and bile duct division in right donor hepatectomy. The setup of the robotic arms, methods of parenchymal transection using robotic instruments, and right hepatic duct division with the aid of indocyanine green dye are detailed, along with the pearls and pitfalls of these two parts of the operation.

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 Rubber band retraction of liver edges.

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  Fig. 3 Parenchymal transection with a robotic Harmonic scalpel and Maryland bipolar forceps.

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  Fig. 4 Segment 5 hepatic vein is clipped before division.

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  Fig. 5 Visualization of the bile duct bifurcation is enhanced by indocyanine green injection on the Firefly (Intuitive Surgical) view. The arrow points to biliary bifurcation.

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  Fig. 6 Clip-and-cut technique; the right hepatic duct is sharply divided proximally after clipping distally.

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  Fig. 7 Laparoscopic suction catheter inserted between the right and middle hepatic vein and lifting the liver off the inferior vena cave to facilitate the final portion of parenchymal transection.

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  Fig. 8 Intraoperative ultrasonography used to ensure the middle hepatic vein is to the left of the transection line.

Reference

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