Yanghee Woo, MD, Jacopo Desiderio, MD, Yuman Fong. City of Hope National Cancer Center
Introduction: Minimally invasive approach for hepatic segmentectomy is feasible, but some concerns regarding limitations for tumors in the posterosuperior segments (VII-VIII here) persist.
A 39-year-old female presented for liver metastases. She previously underwent a low anterior resection for obstructing rectosigmoid cancer. At that time, the disease was staged T4aN1aM1. A CT scan showed a liver mass in segment 8 that gained FDG-avidity at the PET scan, and the MRI revealed two additional small lesions, one in segment 2 and the other in the caudate lobe.
The patient responded to FOLFOX chemotherapy with a decrease of the mass in segment 8 and no evidence of additional lesions. At that point, she was considered eligible for a robotic liver resection.
Procedure details: The procedure was performed with the patient placed in a left lateral position, in slight reverse-Trendelenburg. Pneumoperitoneum was established, and an exploratory laparoscopy with the robotic camera was performed. Under camera vision, four 8 mm robotic trocars and one 12 mm assisting port were placed. The robot was docked with the patient cart approaching the bedside from the patient’s left. The tumor was localized using an ultrasound, which also enabled identification of the main intrahepatic vascular structures (i.e., portal branches and hepatic veins). This allowed for correct marking of the expected resection margins around the tumor. This was facilitated by the TilePro®, which provided a simultaneous view of the operating field and ultrasound. The robotic platform provided additional advantages, such as integrated near-infrared fluorescence imaging (shown in this video). Indocyanine green (ICG) was injected intravenously and allowed for accurate visualization of vascular and biliary structures including perfusion of liver. For transection of the liver parenchyma, the endowristed vessel sealer or Maryland bipolar dissector, and a robotic stapler, were used. The right hepatic vein was dissected to the vena cava and stapled at that point. The resected specimen was put in an Endobag and extracted through the extended right upper quadrant port. Total blood loss for this procedure was approximately 500 mL. There were no major complications. The patient’s postoperative course was uncomplicated, and she was discharged on the third postoperative day.
Conclusion: The Xi robot provides several technological tools, such as multimodality imaging and Endowrist instruments, that improve the feasibility of a minimally invasive challenging liver resection.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79666
Program Number: V151
Presentation Session: Solid Organ Video Session
Presentation Type: Video