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Case Reports
. 2023 Dec 27;15(12):2954-2961.
doi: 10.4240/wjgs.v15.i12.2954.

Awake robotic liver surgery: A case report

Antonella Delvecchio  1 , Gaetano Pavone  2 , Maria Conticchio  1 , Claudia Piacente  2 , Miriam Varvara  2 , Valentina Ferraro  1 , Matteo Stasi  1 , Annachiara Casella  1 , Rosalinda Filippo  1 , Michele Tedeschi  1 , Carmine Pullano  3 , Riccardo Inchingolo  4 , Vito Delmonte  2 , Riccardo Memeo  1
Affiliations
Case Reports

Awake robotic liver surgery: A case report

Antonella Delvecchio et al. World J Gastrointest Surg. .

Abstract

Background: In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease.

Case summary: A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal-epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful.

Conclusion: Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.

Keywords: Awake surgery; Case report; Conscious sedation; Frail patient; Liver resection; Locoregional anesthesia; Robotic surgery.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.

Figures

Figure 1
Figure 1
Multiparameter monitor. Monitor was turned on with parameter detection: electrocardiogram, noninvasive blood pressure and pulse oximetry.
Figure 2
Figure 2
Mechanical ventilation monitor. Monitor was turned off because the patient was breathing spontaneously.
Figure 3
Figure 3
Intraoperative hemodynamic monitoring. A: Stroke volume index curve; B: Stroke volume variation curve; C: Cardiac index curve. SVI: Stroke volume index curve; SVV: Stroke volume variation curve; CI: Cardiac Index curve.
Figure 4
Figure 4
Intraoperative mean arterial pressure: mean arterial pressure. MAP curve. Arrows indicate four boluses of ephedrine. MAP: Mean arterial pressure.
Figure 5
Figure 5
Patient awake in a supine position. A: The patient was awake and placed in the supine position with 30° reverse Trendelenburg under the robotic arms; B: The patient was awake in the absence of an endotracheal tube.
Figure 6
Figure 6
Trocar positions. Patient was placed in a supine position with 30° reverse Trendelenburg position. A pneumoperitoneum was created using an open technique through a supraumbilical incision. The other three robotic trocar, right pararectal, left pararectal and left flank, and two laparoscopic 12-mm trocar assistants, right and left iliac fossa, were inserted under direct vision.
See this image and copyright information in PMC

References

    1. Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D'Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D. The Southampton Consensus Guidelines for Laparoscopic Liver Surgery: From Indication to Implementation. Ann Surg. 2018;268:11–18. - PubMed
    1. Liu R, Wakabayashi G, Kim HJ, Choi GH, Yiengpruksawan A, Fong Y, He J, Boggi U, Troisi RI, Efanov M, Azoulay D, Panaro F, Pessaux P, Wang XY, Zhu JY, Zhang SG, Sun CD, Wu Z, Tao KS, Yang KH, Fan J, Chen XP. International consensus statement on robotic hepatectomy surgery in 2018. World J Gastroenterol. 2019;25:1432–1444. - PMC - PubMed
    1. Story DA. Postoperative complications in elderly patients and their significance for long-term prognosis. Curr Opin Anaesthesiol. 2008;21:375–379. - PubMed
    1. Jin F, Chung F. Minimizing perioperative adverse events in the elderly. Br J Anaesth. 2001;87:608–624. - PubMed
    1. Jayr C, Thomas H, Rey A, Farhat F, Lasser P, Bourgain JL. Postoperative pulmonary complications. Epidural analgesia using bupivacaine and opioids versus parenteral opioids. Anesthesiology. 1993;78:666–76; discussion 22A. - PubMed

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