Surgical removal of tumors in the caudate lobe, a deep and difficult-to-access section of the liver, is known to be one of the most complex procedures in liver surgery. This complexity arises from the caudate lobe's unique anatomical position and its proximity to major blood vessels.
Researchers at Boston University Chobanian & Avedisian School of Medicine have reported that it is possible to safely remove tumors from this region using robotic surgery. Their findings were published in the Annals of Surgical Oncology and detail a clinical case involving a 79-year-old patient with rectal cancer and liver metastasis located in the caudate lobe.
The surgical team used two guidance tools: a hanging or traction technique with the Arantius ligament, and Indocyanine green (ICG) "negative staining" to mark the boundaries of the caudate lobe. The procedure began with intraoperative ultrasound to locate the tumor and map nearby blood vessels. Using a surgical robot, surgeons performed a hanging maneuver with the Arantius ligament to create a safe working space near major vessels. They then temporarily blocked a small portal branch supplying blood to the caudate lobe and injected ICG dye. Under near-infrared imaging, this made most of the liver visible while leaving the caudate lobe dark, allowing clear identification of its borders for safer removal.
Following this step, surgeons also removed the primary rectal tumor robotically. The entire operation was completed using minimally invasive robotic techniques, and according to researchers, the patient recovered without complications after further treatment.
"Our goal is to make complex liver tumor surgery safer and less invasive, so more patients can recover faster and still receive a curative operation. By combining robotic precision with ultrasound and fluorescence guidance, we hope to expand access to high-quality cancer surgery-even for tumors in the hardest-to-reach areas of the liver," said Vega, who is also a hepato-bilio-pancreatic surgeon at Boston Medical Center.
