Robotic Resection of Large Central Hepatic Tumor: Technique of Juxta-Hilar Tumor Dissection Off Anterior Glissonean Pedicle Sheath.
Shivanshu Kumar, Maria Christodoulou, Iswanto Sucandy
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Case in brief
A 24-year-old woman with biopsy-proven focal nodular hyperplasia presented with progressive right epigastric pain and enlargement of a central liver lesion from 4.4 cm to 7.0 cm. Imaging showed the tumor abutting the right anterior Glissonean pedicle without major vascular invasion. Robotic partial central hepatectomy of segments 4A, 4B, 5, and 8, with cholecystectomy, achieved complete resection while preserving major hilar vessels and uninvolved liver. Indocyanine green cholangiography helped delineate biliary anatomy. She had no complications, was discharged on postoperative day 3, and remained symptom-free without recurrence at 1-year follow-up.
What made this case unusual
The technical challenge was removing a large central benign tumor immediately adjacent to a major hilar pedicle while preserving uninvolved liver and critical hilar structures; fluorescence cholangiography supported dissection near the biliary bifurcation.
Diagnostic / clinical pearl
For a central hepatic lesion abutting hilar structures, preoperative assessment of vascular involvement and intraoperative biliary mapping can inform a parenchyma-sparing resection strategy.