Overlapping applications of bipolar-radiofrequency energy for tissue coagulation in a robot-assisted hepatic resection

Pier C Giulianotti, MD, FACS, Mario A Masrur, MD, Gianmarco Contino, MD, Xiaoying Wang, MD, Eduardo Fernandes, MD, Luca Milone, MD, Subhashini Ayloo, MD, FACS

University of Illinois at Chicago

Background: Habib Radiofrequency assisted liver resection allows hepatectomies to be performed with minimal blood loss, a desirable feature in the setting of minimally invasive liver surgery. This video showcases the surgical technique of a minimally invasive left sectionectomy for liver lesion by the use of overlapping fields of Habib radiofrequency and cold blade sectioning.

Material and Methods: A 56 year old women presented for symptomatic cholilithiasis. Ultrasound identified a 5cm left lateral lobe liver mass that was further characterized with MRI imaging.

Results: After camera port positioning and assessment of the lesions, two 10-mm trocars on both sides of the umbilicus, two 8-mm trocars in the left-upper quadrant, and one 8-mm size trocar in the right-upper quadrant were placed and the daVinci robot was docked cranially. First, the triangular ligament was dissected and an intraoperative ultrasound confirmed the involvement of the segment II/III. ICG fluorescence evaluation adjuncted the visualization of the limits of the tumor. Habib Radiofrequency was applied in overlapping fields of energy along the section line and a bloodless cold knife sectioning of liver parenchyma was performed with hemostatic prolene suture to control main hepatic pedicels. Blood loss was under 50cc and postoperative course was uneventful. Pathology examination reported a 6cm hepatocellular carcinoma with neuroendocrine differentiation with negative margins.

Conclusions: Overlapping field of Habib Radiofrequency allows bloodless cold knife parenchymal dissection of the liver and can be incorporated safely in minimally invasive procedures. Use of fluorescence proved useful in identifying safe margins of resection.

Session: Video ChannelDay 2

Program Number: V071

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