James C Padussis, MD, David L Bartlett, MD, Melissa E Hogg, MD, Herbert J Zeh, MD, Amer H Zureikat, MD. University of Pittsburgh Medical Center
Patients with unresectable hepatic metastases from colorectal cancer have a poor prognosis, with a median survival of only 15-20 months with systemic chemotherapy alone. For these patients, liver-directed therapy with hepatic arterial infusion of cytotoxic drugs offers an additional approach to improve control of metastatic disease. One of the main arguments against the use of hepatic arterial infusion therapy however, is that the pump carries long-term morbidity, and that the insertion procedure involves a major operation via an upper-midline or subcostal incision. Laparoscopic hepatic artery infusion catheterization has been described in several case series and has been shown to reduce post-operative pain and shorten recovery time over traditional open surgery. The laparoscopic procedure however is technically difficult, requiring extreme accuracy, fine dissection and endoscopic suturing. We present a series of ten robotic-assisted placement of hepatic artery infusion pump and catheter as a technically more feasible alternative to the laparoscopic approach while still offering the benefits of minimally invasive surgery.