A Practical Guide to Inflow Control, Retraction, and Exposure for Robotic Hepatectomy

Area of Science:

• Minimally Invasive Surgery
• Hepatobiliary Surgery
• Surgical Techniques

Background:

• Safe hepatectomy requires effective liver retraction and inflow control.
• Minimally invasive hepatectomy (MIS) presents unique challenges for these maneuvers.
• Existing methods for inflow control, like Huang's Loop, have limitations.

Purpose of the Study:

• To describe a modified Huang's loop for adjustable, atraumatic, intracorporeal inflow control during MIS hepatectomy.
• To present a novel liver sling technique for gentle, effective liver retraction.
• To detail cost-efficient and reproducible methods for enhancing surgical exposure in MIS hepatectomy.

Main Methods:

• A modified Huang's loop was created using a urinary catheter for adjustable, intracorporeal inflow control.
• A liver sling fashioned from a surgical sponge with silk ties was employed for atraumatic retraction.
• External band retraction was utilized to align the transection plane with the camera.

Main Results:

• The modified loop allows easy tightening and loosening for precise inflow control.
• The liver sling provides gentle, adjustable retraction, particularly useful for posterior sectors.
• These techniques offer effective countertraction for instrument advancement in challenging liver parenchyma.

Conclusions:

• The described modified Huang's loop and liver sling are effective, reproducible, and cost-efficient adjuncts for MIS hepatectomy.
• These techniques improve liver exposure and facilitate safe hepatectomy in a minimally invasive setting.
• The methods enhance surgical safety and efficiency in complex liver resections.