Tumor resection in the caudate lobe (a deep and hard-to-reach part of the liver) is recognized as one of the most technically challenging operations in liver surgery due to its unique anatomical location and complex vascular relationships.
Researchers at Boston University’s Chobanian and Avedisyan School of Medicine have shown that it is possible to safely remove the caudate lobe and completely remove cancer even in elderly patients using a surgical robot. The clinical example they describe in the journal Annals of Surgical Oncology combines two “guidance” tools: (1) a suspension/traction technique using the ligament of Alanthius, and (2) an indocyanine green (ICG) “negative stain” to clearly mark the borders of the caudate lobe and guide margin-focused cancer surgery in a highly difficult area.
“The caudate lobe is one of the most technically demanding regions of the liver; it is deep and surrounded by important blood vessels,” said corresponding author Eduardo Vega, MD, assistant professor of surgery. “Robotic surgery helps remove selected tumors through smaller incisions while aiming for a cure, resulting in faster recovery with less pain and blood loss.”
The researchers describe step-by-step the surgical technique they used to treat a 79-year-old patient with rectal cancer and caudate liver metastases. They first used intraoperative ultrasound to locate the tumor and map nearby important blood vessels. A surgical robot was then used to perform a hanging maneuver using the Arantius ligament to create a safe working space near major blood vessels. We then temporarily blocked the small portal vein branch feeding the caudate lobe and injected a small amount of ICG dye (2.5 mg). In the near-infrared camera, the rest of the liver became brighter, and the caudate lobe remained dark. This allowed the surgeon to clearly see the border and protect critical structures while removing the caudate lobe.
After liver surgery, the primary tumor (upper rectal cancer) was removed robotically. This made radical cancer resection completely possible using a minimally invasive robotic approach, and the patient completed subsequent treatment without complications.
“Our goal is to make complex liver tumor surgery safer and less invasive, allowing more patients to recover faster and undergo curative surgery. By combining robotic precision with ultrasound and fluorescence guidance, we hope to expand access to high-quality cancer surgery, even for tumors in the most difficult-to-reach areas of the liver,” added Vega, who is also a hepatobiliary and pancreatic surgeon. boston medical center.
sauce:
Boston University School of Medicine
Reference magazines:
DOI: 10.1245/s10434-026-19261-5
