Related Experiment Video
Updated: Mar 7, 2026
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Robotic Caudate Lobectomy for a Solitary Colorectal Liver Metastasis Using Arantius‑Ligament Hanging and ICG Negative
Samia Ellias1, Andrew B Crocker1, Rishi Jonnala1
1Department of Surgery, Boston Medical Center Brighton, Boston, MA, USA.
Background:
Minimally invasive liver surgery offers a caudal "look-up" view that may facilitate caudate lobe resection.1,2 In this video, we demonstrate a robotic total caudate lobectomy (high dorsal resection) using an Arantius-ligament hanging maneuver, indocyanine green (ICG) negative staining, and intraoperative ultrasound (IOUS).
Case Description:
A 79-year-old woman with mid-rectal adenocarcinoma developed a solitary caudate lobe metastasis. She received neoadjuvant FOLFOX (4 cycles) and experienced an ischemic stroke with full neurologic recovery. After multidisciplinary review and medical optimization, curative-intent local therapy was recommended. We performed a robotic total caudate lobectomy (Spiegel lobe, paracaval portion, and caudate process) with Arantius-ligament hanging, IOUS guidance, and ICG negative staining. Operative time was 316 minutes; estimated blood loss was 200 mL. Intermittent Pringle occlusion totaled 55 minutes. Length of stay was 5 days. Final pathology demonstrated metastatic colorectal adenocarcinoma (3 cm) with an R0 resection (closest margin <1 mm).
Conclusions:
Robotic high dorsal resection is feasible in selected patients. Combining Arantius-ligament hanging with IOUS and ICG negative staining provides stable exposure along the retrohepatic inferior vena cava and objective segmental delineation to support a margin-oriented segment I resection.
