Related Experiment Video
Updated: Jun 17, 2026
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Robotic Anatomic Segmentectomy 8 of the Liver Using a Hepatic Vein-Guided Approach and Indocyanine Green Fluorescence
Ji Hoon Kim1, Byeong-Gon Na2, Jimin Son3
1Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College Medicine, Seoul, Korea. asist10@hanmail.net.
Background:
Anatomic segmentectomy 8 of the liver is among the most technically demanding procedures, primarily because of the deep intraparenchymal location and marked anatomic variability of the segment 8 Glissonean pedicle (G8) and the inherently curved configuration of the intersegmental planes. The cranial hepatic vein-guided approach (HVGA) combined with indocyanine green (ICG) fluorescence imaging offers a rational and reproducible strategy for achieving accurate anatomic resection.
Methods:
The authors performed robotic anatomic segmentectomy 8 using a stepwise strategy integrating three complementary elements: (1) cranial root-side exposure of the middle hepatic vein (MHV) to establish a stable anatomic axis, (2) intersegmental vein (ISV)-guided localization of G8 exploiting the consistent anatomic relationship between the ISV between segments 5 and 8 and the G8 root, and (3) ICG-negative staining for real-time delineation of the segment 8 portal territory.
Results:
The operative time was 180 min, with an estimated blood loss of 10 mL. No intraoperative transfusion was required. The Pringle maneuver was applied intermittently for a cumulative duration of 45 min. A 30-mm hepatocellular carcinoma was resected with a clear surgical margin of 11 mm. The postoperative course was uneventful, and the patient was discharged on postoperative day 7.
Conclusions:
Robotic anatomic segmentectomy 8 using a cranial HVGA integrated with ICG fluorescence imaging enables precise identification of G8 and accurate navigation along the curved intersegmental planes of S8. This three-element integrated strategy provides an anatomically grounded, reproducible framework for safe and complex robotic anatomic segmentectomy.
