Fluorescent Positive Staining of the Hepatic Segments in Robotic Anatomical Hepatectomy: A Preliminary Report

Anatomical segmentectomy of the liver is a standard procedure used in hepatocellular carcinoma (HCC) resections. In laparoscopic hepatectomy, negative staining of the hepatic segments is predominantly used because the direct puncture of the portal branches under the guidance of intraoperative ultrasonography (IOUS) is technically demanding. Alternatively, in robotic hepatectomy, intracorporeal positive staining of the hepatic segments may be feasible.

Positive staining of the hepatic segments to be removed (segment 3 in four cases and segment 6 in one case) was performed. The diseases were HCC (n = 3) and colorectal liver metastases (n = 2). The tip of the 22G needle attached to the extension tube was placed in the target portal vein branch under IOUS guidance with Maryland bipolar forceps. After injection of indocyanine green solution, the boundary of the target segment visualized in the Firefly mode was easily marked with monopolar curved scissors. Positive staining for S3 and S6 was successful in four of the five cases. Anatomical segmentectomy and partial resection of the liver were performed in three and two patients, respectively.

It was feasible to perform positive staining of the hepatic segments under IOUS in robotic hepatectomy, owing to the multijoint function and stability of the robotic arms.