Robotic Central Bisectionectomy for Centrally Located Hepatic Malignant Tumor.

Introduction: Laparoscopic hepatectomies for centrally located tumors are classified as advanced and complex surgical procedures. Because of some limitations in robotic liver surgery, robotic central bisectionectomy has rarely been performed. We introduce useful tips for robotic central bisectionectomy in this multimedia article.

Methods: A 67-year-old male with a 4.4-cm-sized, hepatocellular carcinoma involving segments IV and VIII underwent robotic central bisectionectomy. This video demonstrates technique of determination of resection line, traction methods, effective use of robotic instruments for parenchymal transection, application of Pringle's maneuver, and indocyanine-green fluorescence image in robotic central bisectionectomy.

Results: Total operative time was 320 min and intraoperative blood loss was 200 ml without transfusion. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day in good condition. Pathological assessment indicated that the mass was a hepatocellular carcinoma 4.5 cm in size with a surgical margin of 1.5 cm.

Conclusions: Central bisectionectomy is one of the most demanding surgical procedures with long operative times. However, robotic central bisectionectomy can be safely performed with proper exposure technique and an appropriate combination of several useful technical tips.