Early experiences of robotic-assisted laparoscopic liver resection

Abstract

Purpose: The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentations. Robotic surgery for hepatic resection has not yet been extensively reported.

Patients and methods: Between March and May 2007, we performed 3 robot-assisted left lateral sectionectomies of the liver. Case 1 had a hepatocellular carcinoma (HCC), case 2 had colon cancer with liver metastasis, and case 3 had intrahepatic duct stones.

Results: All patients had successful operation and recovered without complications. Shorter length of hospital stays, earlier start of oral feeding and less amount of ascites were found. However, case 1 had recurrent HCC at 3 months after operation.

Conclusion: Robotic-assisted liver surgery is still a new field in its developing stage. In patients with small malignant tumors and benign liver diseases, robotic-assisted laparoscopic resection is feasible and safe. Through experience, the use of robotics is expected to increase in the treatment of benign diseases and malignant neoplasms. However, careful patient selection is important and long-term outcomes need to be evaluated.

Fig. 1

CT (A) and MRI (B) show a 2 cm mass consistent with HCC in segment II. HCC, hepatocellular carcinoma.

Fig. 2

CT shows a hypodense, 1.5 cm mass (A) in segment III consistent with metastasis and an ulcerofungating mass (B) with minimal pericolic fat infiltration at the rectosigmoid junction.

Fig. 3

Precontrast CT shows IHD and CBD dilatation with several radiopaque stones in liver segment II (A) and a 6 mm calcified stone in the distal CBD (B). IHD, intrahepatic duct; CBD, common bile duct.

Fig. 4

Operative procedures. Intraoperative ultrasonography for detecting other lesions and determining resection margins (A). Dissection of falciform ligament and ligamentum venosum after detaching the left triangular ligament using a harmonic scalpel (B and C). Parenchymal dissection using a harmonic scalpel and electrocautery (D).

Fig. 5

Suture for Glissonian pedicle (A) and endo-GIA for division of hepatic vein (B).

Fig. 6

A 3-month follow-up CT showed multiple intrahepatic masses compatible with HCC with tumor thrombi in the main portal trunk (A). PET scan shows multiple strong F-18 FDG uptakes at the liver and pelvic bone (B and C). HCC, hepatocellular carcinoma; PET, positron emission tomography.