The robotic-assisted left lateral hepatic segmentectomy: the next step

Abstract

Introduction: During the last decade, minimally invasive surgery had an astonishing development, progressing from minor hepatic interventions to major hepatectomies, thus creating a rich background for robotic-assisted hepatic surgery. Left lateral hepatic segmentectomy (left lobectomy, II-III bi-segmentectomy) is the first anatomic hepatic resection on the learning curve. The purpose of this report is to demonstrate that, due to the anatomical characteristics of the left lobe and to the technical facilities of the robot, this intervention is also feasible with the Da Vinci S robotic system.

Materials: In our department, robotic-assisted left lateral lobectomy was performed for both benign and malignant lesions by a surgeon experienced in both hepatic and laparoscopic surgery but traversing the beginning of the learning curve in robotic surgery. A Da Vinci S robotic system with three arms was used and two additional laparoscopic ports for the assistant surgeons were added.

Results: The lobectomies were safely performed in an average operatory time of 140 min (+/- 20), with minimal blood loss and without using the Pringle procedure. The dissection was carried out with the bipolar forceps on the left arm of the surgeon and the Harmonic curved shears on the right arm. The division of the vascular pedicles for segments II and III was performed with the LigaSure Atlas device. The other additional port was used for retraction. There were no conversions or reinterventions

Discussions: Robotic-assisted left lateral hepatic lobectomy was a feasible technique with the potential to reduce surgical trauma and pain and to improve surgeon's technical comfort.