Valentina Valle, MD, Alberto Mangano, MD, Eduardo Fernandes, MD, PhD, FRCS, Luis F Gonzalez-Ciccarelli, MD, Pier Cristoforo Giulianotti, MD, FACS. University of Illinois at Chicago
Introduction: This is the case 41 year-old male. Past Medical History: Rectal adenocarcinoma treated by neoadjuvant chemotherapy and low anterior resection. History of presenting illness: during adjuvant chemotherapy, the known right liver lobe metastatic lesions increased in size (CT and MRI assessment). The patient underwent a right portal vein embolization. Procedure performed: elective robot-assisted Right Hepatectomy. Operative time: 331 minutes.
Mehtods and Procedures: Dissection of the hepatic hilum with accurate skeletonization, identification and dissection of the vascular and biliary structures. [AM1] The intraoperatory US confirmed that one lesion [AM2] was deeply located into the parenchyma. Hence, a complete right liver resection was required. A bulldog was placed on the two right hepatic arteries (RHA) to get clear ischemic demarcation before parenchymal transection. RHA division. Right main duct division previous ICG-check. Right portal vein division in between sutures. Vena cava exposure, division of the accessory vein from the caudate lobe. Two stay-sutures on both sides of the resection line. Parenchyma division by Harmonic and some hemostatic 3-0. Prolene stitches. Stapler-mediated completion of the right lobe division/sealing main drainage into the vena cava. Hemostasis check. Fibrin glue on the transection surface. Falciform ligament fixed to the diaphragm (to avoid kinking of the vascular pedicle on the hepatic veins). Two drains near the section line. Undocking. Specimen extraction by Pfannenstiel incision.
Results: Overall estimated blood loss: 150 ml. No blood transfusions were necessary. Uneventful post-operatory course. Discharge: POD 4. Pathology Report: three metastatic lesions of rectal adenocarcinoma in the right lobe of the liver (TXN0M1a). Resection margins: tumor free.
Conclusion: Robotic right hepatectomy is a safe procedure, it can allow reduced blood loss (no transfusion needed in this case) and conceivably a better oncological outcome, it has a short hospitalization period and good quality of life. Robotic surgery has potentially superior outcomes in comparison with laparoscopy. These improved results are related to the stability of the platform, the tremor filtering technology and the magnified 3D stereotactic vision. These features allow meticulous and accurate surgical maneuvers. More trials are needed to better establish the role of robotic approach in the liver surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94229
Program Number: V027
Presentation Session: HPB Videos
Presentation Type: Video