Alexander L Marinica, DO, Lindsay Nelson, DO, Fazal Din Moghul, DO, Abubaker Ali, MD, FACS. Sinai Grace Hospital, Detroit Medical Center
This is a case presentation of a cholecystectomy and resection of a benign liver mass using the robotic platform. The patient is a 36-year-old female who was originally seen by a colleague surgeon for complaint of epigastric pain and nausea. Ultrasound showed cholelithiasis without signs of acute cholecystitis and 2 gallbladder polyps (5-6mm). A pre-operative CT-scan was performed and read as normal, and an EGD showing gastritis and biopsy positive H. pylori. The patient was treated for H. pylori, but continued to be symptomatic. Thus, the patient was scheduled for cholecystectomy. Upon entering the abdomen, the surgeon noted a large mass (5x5cm) adjacent to the gallbladder fossa in Segment 4. The procedure was aborted and the patient was referred to our clinic after a MRI-liver protocol was completed. The MRI showed a central scar most indicative of fibronodular hyperplasia (FNH), however, fibrolamellar carcinoma or adenoma were not excluded, and the previously described gallbladder polyps were also noted. Due to the gallbladder polyps, the continued symptoms and the liver mass, robotic assisted cholecystectomy and resection of the liver mass were discussed with the patient who was adamant about going forward with the procedure. Robotic excision was performed via a four-port (plus 2 assistant ports), transabdominal, transperitoneal approach. The final pathology was consistent with benign hepatocellular nodule (4.5cm), surgically clear margins, and gallbladder with cholelithiasis and mild chronic cholecystitis, negative for malignancy. The procedure was completed in one hour and forty-one minutes with 50cc of blood loss, and the post-operative hemoglobin remained unchanged on discharge on post-operative day 2. The patient was seen post-operatively at 2 weeks and 3 months, with no new complaints and complete resolution of her previous pain. This is a case demonstrating a safe resection of a liver mass using the robotic platform.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95732
Program Number: V161
Presentation Session: Video Loop Day 1
Presentation Type: VideoLoop