Robotic Right Posterior Sectionectomy <i>via</i> a Caudate Lobe-first Approach: Surgical Technique and Outcomes

BACKGROUND/AIM: Robotic right posterior sectionectomy (RRPS) remains a technically challenging procedure. However, few studies have reported surgical approaches for RRPS. Herein, we present surgical techniques for a caudate lobe-first approach in RRPS. PATIENTS AND METHODS: Following the mobilization of the right lobe of the liver, the paracaval portion of the caudate lobe was dissected along the inferior vena cava, and the right posterior Glissonean pedicle (RPGP) was encircled (the caudate lobe-first approach). The demarcation line was confirmed using Firefly fluorescence imaging, followed by the division of the RPGP. Finally, the right posterior section, with or without the right hepatic vein, was resected. RESULTS: Between November 2024 and January 2026, five patients underwent RRPS using the caudate lobe-first approach. The mean operative time and estimated blood loss were 194 (standard deviation 54) min and 170 (83) ml, respectively. Using the caudate lobe-first approach, the RPGP can be safely encircled at an early phase. Confirmation of the demarcation line in the early phase can help guide the liver dissection line. CONCLUSION: The caudate lobe-first approach appears to be safe and effective for performing RRPS.