Sequential Portal Vein Ligation and Robotic-Assisted Hepatectomy Following Conversion Therapy for Initially Unresectable Hepatocellular Carcinoma

The goal of this protocol is to present a comprehensive multimodal approach for treating hepatocellular carcinoma (HCC) that is initially considered unresectable due to insufficient future liver remnant or advanced tumor burden. The strategy integrates oncological conversion therapy with functional liver regeneration techniques, followed by minimally invasive robotic resection. First, targeted therapy, immunotherapy, and interventional vascular treatment are applied to control tumor progression and enhance resectability. Subsequently, laparoscopic right portal vein ligation is performed to induce hypertrophy of the contralateral liver, ensuring adequate functional reserve. After reassessment, patients meeting surgical criteria undergo Da Vinci robot-assisted anatomical right hepatectomy using an anterior approach, which allows precise vascular dissection, reduced blood loss, and improved surgical safety. This protocol highlights the feasibility and advantages of combining systemic therapy, interventional procedures, and advanced robotic techniques to expand surgical eligibility, optimize perioperative outcomes, and achieve favorable oncological control in patients with complex or advanced HCC.