Mike Fruscione, MD, MBA, Russell Kirks, MD, Erin Baker, MD, David Iannitti, MD, Dionisios Vrochides, MD, John Martinie, MD. Carolinas Medical Center
Objective: First described in 2012, Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy (ALPPS) procedure is a two-staged resection of advanced primary and metastatic liver tumors predicated on the regenerative capacity of the liver. Our aim is to highlight the technique of performing a robot-assisted ALPPS procedure.
Methods: A 69-year old male with rectal cancer status post low anterior resection and metachronous liver tumor burden dominating the right hemi-liver along with small satellite lesions occupying segments 4a/b and segment 2 presented following completion of systemic chemotherapy with eight cycles of FOLFOX and bevacizumab. Preoperative CT volumetrics demonstrated a future liver remnant/total liver volume ration (FLR) of 27% (not taking into account the volume of liver parenchyma that needed removal/ablation to address the segment 2 lesion). Right portal vein embolization was not feasible secondary to the proximity and size of the right hemi-liver tumor burden relative to the right portal vein. The pre-operative planned procedure was a right trisectionectomy and microwave ablation of the segment 2 lesion.
Results: Using the da Vinci Xi Surgical System (Intuitive Surgical, Inc.) the right portal vein was dissected, doubly-ligated, and divided. The liver parenchyma was split from the inferior edge to the dome 5mm medial to the falciform ligament and down to the middle hepatic vein which was preserved to maintain adequate venous outflow. The patient was discharged home on post-operative day two. On post-operative day six, CT volumetrics demonstrated a FLR of 47%. On post-operative day seven, a second stage ALPPS procedure was performed where the right hepatic artery, middle and right hepatic veins and right hepatic duct were ligated and divided. Segments 4a/b, 5, 6, 7 and 8 were removed. The patient was discharged home on post-operative day five. Surgical pathology confirmed negative margins.
Conclusion: Robot-assisted ALPPS procedure is a feasible alternative to a laparoscopic or an open procedure when performed in high volume centers with advanced robotic expertise.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86700
Program Number: P797
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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