Search

Introduction: Robotic‐assisted surgery has become increasingly popular because of its potential benefits. Anatomical liver resection (ALR) is a valuable strategy in hepatocellular carcinoma (HCC) management. ALR with indocyanine green (ICG) fluorescence navigation was reported as an effective solution for segment identification. We reported a simple and convenient "preoperative positive staining technique" for laparoscopic ALR to overcome some limitations. To our knowledge, this is the first report of robotic‐assisted surgery in which ALR was performed using this technique. Materials and Surgical Technique: A 69‐year‐old man presented with a 12‐mm HCC in segment 8. Preoperative three‐dimensional simulation images showed that the fourth‐order branch of the portal vein was a tumor‐bearing portal pedicle. After anesthesia induction, 1 mL of 0.025 mg/mL ICG was injected percutaneously into this branch under B‐mode ultrasound guidance before pneumoperitoneum. A robotic laparoscope was inserted. The preoperative positive staining area was clearly stained on the liver surface with the Firefly mode on the da Vinci Xi system. Based on the demarcation line, the liver parenchymal resection was started. The ICG fluorescence staining area was checked frequently on the resected side of the liver transection plane. Subsequently, the fourth‐order portal branch was identified with the ICG fluorescence technique and ligated. Finally, the specimen was resected. The operation took 352 min, with 10 mL of blood loss, and was completed without any operative problems. Discussion: Although many cases are required, the proposed preoperative positive staining technique appears useful for accurate and precise surgery given the increasing application of robotic‐assisted hepatectomy. [ABSTRACT FROM AUTHOR]

The Gore-Tex® polytetrafluoroethylene patch is one of the most used prostheses for diaphragm, vessel, and pericardial reconstruction. It is strong, flexible, and relatively inexpensive and can be fitted to match the size of the resected area. In addition, it can be used to reconstruct the pericardium and diaphragm following resection to treat diffuse malignant pleural mesothelioma or repair large hiatal hernias. However, the use of polytetrafluoroethylene for hepatocellular carcinoma with diaphragmatic and pericardial invasion has not yet been reported. We report the case of a 72-year-old man with hepatocellular carcinoma with diaphragmatic and pericardial invasion. Subsequently, laparotomic liver subsegmentectomy of segment 3 and resection of the diaphragm and pericardium were performed. The defects were successfully reconstructed using the polytetrafluoroethylene patch, without postoperative complications. This is the first report describing a case of invasive liver malignancy that required simultaneous diaphragmatic and pericardial reconstruction using a polytetrafluoroethylene patch, indicating that the polytetrafluoroethylene patch could effectively and directly treat invasive liver malignancies. [ABSTRACT FROM AUTHOR]

This preliminary study is the first to demonstrate that AI can precisely identify loose connective tissue during laparoscopic cholecystectomy and ICG fluorescent cholangiography. Tashiro and colleagues conclude that this novel real-time navigation modality fusing AI and ICG fluorescent imaging may enhance safety and provide more reliable laparoscopic or robotic surgery., (© 2024 Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.)

Tashiro and colleagues demonstrated for the first time that an artificial intelligence system can precisely identify intrahepatic vascular structures during laparoscopic liver resection in real time through color coding under bleeding and indocyanine green fluorescent imaging. The system supports real-time navigation and offers potentially safer laparoscopic or robotic liver surgery., (© 2023 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)