Subhashini Ayloo, MD, MPH, Jacob Schwartzman, MD. Rutgers, New Jersey Medical School
Objective: To demonstrate the safety and feasibility of robot-assisted right hepatectomy in a septuagenarian without the implementation of Pringle maneuver.
Materials & Methods: A 72 year old man presents with right upper quadrant abdominal pain. Diagnostic imaging showed a large complex mass. Characteristics are consistent with hemangioma but primary liver malignancy cannot be ruled out secondary to multiple nodules within this large mass.
This video showcases the technical details of a minimal invasive approach to right hepatectomy. A diagnostic laparoscopy is performed, showing significant adhesions to the lesion and the complex, nodular, multi-colored characteristics of the lesion. A cholecystectomy is performed, followed by marking the resection line from gallbladder fossa to right hepatic vein. A stay suture is placed in the inferior portion of segment 4 to retract the left lobe laterally. Intraparenchymal dissection is performed using a combination of monopolar scissors, bipolar cautery and staplers towards hepatic vein branches. Any branches of the hilar blood vessels are suture ligated when encountered. Parenchymal transection is the most time consuming part of the operation. The specimen is extracted via a Pfannensteil incision.
Conclusions: Robot-assisted right hepatectomy in a septuagenarian is safe and feasible. The Da Vinci system provides a stable platform with 3-D visualization and improved ergonomics, which facilitate suture ligation at difficult angles of blood vessels as they are encountered and does not require Pringle maneuver.
Educational/Technical Points: The camera is positioned right mid-abdomen, with the left and right arms of the surgeon on either side. The robotic fourth arm is placed in a left lateral position, and a first assistant port is placed inferomedial to the surgeon’s left arm. The 4th arm of the robot has a multifunctional purpose in retracting the left lobe to keep the resection plane in alignment to camera. The degrees of freedom afforded by the robotic system allow for suturing at difficult angles as the blood vessels are encountered and the obviate need for Pringle maneuver.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92380
Program Number: V300
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop
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