Robotic Single-Port Right Hepatectomy: Unveiling New Possibilities

Minimally invasive liver resections, particularly right hepatectomy, are technically challenging. Single-port (SP) laparoscopic liver resection has been constrained by restricted triangulation and unfavorable ergonomics.¹ The robotic SP platform offers enhanced dexterity, 3D visualization, and wristed instrumentation that may overcome these limitations.^{2, 3} Nevertheless, its use in major hepatectomy is currently limited, and only a few early experiences have been reported.^{4, 5} We present a case demonstrating the technical feasibility and perioperative safety of robotic SP right hepatectomy in a patient with intraductal papillary neoplasm of the bile duct (IPNB) further complementing our recently published series.⁶ METHODS: A 66-year-old male with IPNB in segment 6 with right lobe atrophy underwent robotic SP right hepatectomy using the da Vinci SP® system. The patient was placed in a 30° head-up and 15° right-up semi-lateral position. A 5-cm transumbilical main port and a 12-mm assistant port were used. A 2-mm percutaneous puncture was used for rubber-band traction without trocar insertion and later served to exteriorize the drain. Inflow was intermittently controlled using a Pringle maneuver (video).

The procedure was completed successfully without conversion or additional ports. Operative time was 241 minutes and estimated blood loss was 100 mL without transfusion. Pathologic examination confirmed IPNB with high-grade dysplasia and no invasion. Resection margins were negative. The patient was discharged on postoperative day 7 without complications.

This case demonstrates the technical feasibility and perioperative safety of robotic SP right hepatectomy in complex hepatobiliary disease. Although limitations remain - such as restricted working space and lack of integrated energy devices - the ergonomic and precision advantages of the SP platform suggest potential for broader adoption and improved clinical outcomes.