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Updated: Jul 9, 2025

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst

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A robotic left S1+2c subsegmentectomy using preoperative simulation.

Hitoshi Igai¹, Kazuhito Nii², Mitsuhiro Kamiyoshihara³

¹Department of General Thoracic Surgery Maebashi Red Cross Hospital Maebashi 3-21-36 Asahi-cho Maebashi, Gunma 371-0014 Japan.

Multimedia Manual of Cardiothoracic Surgery : MMCTS

|December 7, 2023

Summary

Robotic subsegmentectomy, a rare procedure, was successfully performed using a high-definition 3D view and precise robotic movements. Preoperative simulation aided in achieving adequate surgical margins, despite the lack of tactile feedback.

Keywords:

3D simulation Complex segmentectomy Minimally invasive thoracic surgery Robot Robotic surgery Subsegmentectomy

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Area of Science:

Thoracic Surgery
Minimally Invasive Surgery
Robotic Surgery

Background:

Robotic subsegmentectomy is rarely reported due to the need for precise anatomical knowledge and exposure of subsegmental pulmonary vessels and bronchi.
Robotic surgery offers advantages like a high-definition 3D surgical view and tremorless precision, potentially simplifying complex procedures.

Discussion:

The robotic approach facilitated a successful left S1+2c segmentectomy with a short console time and favorable postoperative outcome.
Preoperative simulation proved valuable for ensuring adequate surgical margins.
Lack of tactile feedback in robotic surgery presents challenges in intraoperative tumor localization compared to thoracoscopic approaches.

Key Insights:

Robotic surgery can be effectively utilized for complex pulmonary subsegmentectomies.
Preoperative simulation is a critical tool for optimizing surgical margins in robotic thoracic procedures.
Careful planning and simulation can overcome the limitations of tactile feedback in robotic surgery.

Outlook:

Further research into robotic techniques for pulmonary subsegmentectomy is warranted.
Integration of advanced simulation and navigation may enhance intraoperative precision and tactile feedback simulation.
Robotic subsegmentectomy holds promise for improving patient outcomes in minimally invasive lung cancer surgery.