Related Experiment Video
Updated: Jan 12, 2026
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
How I do it: robotic living donor right hepatectomy with a focus on parenchymal transection
Na Reum Kim1, Gi Hong Choi2, Dai Hoon Han1
1Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Background:
Living donor liver transplantation provides a solution to the shortage of deceased donor organs. As minimally invasive donor hepatectomy has gained popularity, robotic techniques offer clear advantages, such as enhanced visualization, precision, and ergonomics.
Methods:
Our institution began robotic liver surgery in 2008 and introduced robotic donor hepatectomies in 2016. With growing experience, we established a standardized approach for robotic donor right hepatectomy (RDRH), focusing on parenchymal transection and bile duct division.
Results:
We suggest a zone-based approach along the middle hepatic vein by dividing the transection plane into four zones based on venous territories. This systematization improves the orientation, minimizes bleeding, and facilitates precise dissection. Key anatomical landmarks, such as segmental veins (V5 and V8), the Laennec's capsule, and intersegmental veins, guide the dissection. Supplementary Videos and Figures for each step demonstrate specific techniques, including the inter-Laennec approach and modified hanging maneuver. Bile duct division is guided by indocyanine green fluorescence and performed using either a "clip and cut" or "cut and suture" method, chosen based on individual duct anatomy.
Conclusions:
Robotic articulation facilitates secure closure even in anatomically challenging cases. These standardized techniques enable reproducible outcomes and support their safe adoption by centers new to RDRH.
