Optimizing Safety in Robotic-Assisted Right Hepatectomy With Techniques for Complete Vascular Control of the Left and Middle Hepatic Veins: A Case Report.

Robotic right hepatectomy remains technically challenging, particularly due to the risk of bleeding from the left and middle hepatic veins during parenchymal transection. We present the case of a 71-year-old woman with colorectal adenocarcinoma and an isolated segment 7 hepatic metastasis involving the right hepatic vein who underwent robotic-assisted right hepatectomy after neoadjuvant chemotherapy. Key operative maneuvers were employed to ensure safe vascular control, including extrahepatic control of the left and middle hepatic veins, intraoperative ultrasound guidance for vascular mapping, indocyanine green (ICG) assessment of hepatic perfusion, and intermittent Pringle maneuver application during parenchymal transection. The estimated blood loss was 100 mL, with no transfusion requirement or bile leak. This case demonstrates that complete inflow and outflow control during right hepatectomy is feasible with the robotic platform and may improve operative safety in these patients.