Tadahiro Uemura, MD, PhD, Molly Vincent, PAC, Lorenzo Machado, MD, Kiumars Tabar, MD, Ngoc Thai, MD, PhD. Allegheny General Hospital
Background: Robot-assisted surgery is rapidly expanding in many surgical fields. However, robotic liver resections are still performed only in specialized centers. By utilizing advanced robotic technology, liver surgery can become safer and more effective than with traditional laparoscopic techniques. In this video, we demonstrate a robot-assisted laparoscopic right hepatectomy. We also show indocyanine green (ICG) -fluorescence imaging with a clear demarcation line for hepatic parenchymal resection.
Case report: This video illustrates a robotic right hepatectomy in a 68 year-old female with metastatic squamous cell carcinoma to the liver. Hilar dissection and ligation of vascular inflow to the right lobe (right hepatic artery and right portal vein) were performed, followed by administration of 2.5mg of ICG intravenously. The demarcation line between right and left hepatic lobes was clearly shown under ICG fluorescence imaging. Therefore, the resection line was more accurately determined under ICG fluorescence than via the usual ischemic demarcation using only visual cues. Hepatic parenchymal dissection was performed along the ICG fluorescence line via anterior approach. The right hepatic duct with hilar plate was divided with an endoscopic vascular stapler. The right hepatic vein was also divided using an endoscopic vascular stapler. Thereafter, posterior mobilization of the right liver was performed and the specimen was removed from a small lower abdominal incision.
Result: The operative time was 470 min. Blood loss was 200ml and no blood transfusion was required. She resumed a regular diet the next day and was discharged on postoperative day 6.
Summary: Robotic liver resection is a safe and feasible option for major liver resections. Robotic liver resection can be performed in a similar fashion and with the same operative sequence as open liver resections. The ICG fluorescence system is a useful tool to delineate liver parenchymal resection line and plane. It can provide precise hepatic resections.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86520
Program Number: V129
Presentation Session: Friday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo