Marcel Autran Machado1,2, Rodrigo C Surjan3,4, Tiago Basseres4, Fabio Makdissi4,5. 1. Department of Surgery, University of São Paulo, São Paulo, Brazil. dr@drmarcel.com.br. 2. Nove de Julho Hospital, São Paulo, Brazil. dr@drmarcel.com.br. 3. Department of Surgery, University of São Paulo, São Paulo, Brazil. 4. Nove de Julho Hospital, São Paulo, Brazil. 5. Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: Repeat hepatectomy often is required for primary and metastatic tumors. The purpose of this video was to present a robotic repeat hepatectomy for recurrent colorectal metastasis after multiple previous open surgeries. PATIENT: A 64-year-old man underwent open left colectomy complicated by anastomotic leak. He was reoperated for colostomy, which was reverted. One year later, he underwent open metastasectomy. Recently, he presented a recurrence in the right liver, and a robotic right hepatectomy was indicated. TECHNIQUE: This approach used five trocars. The operation began with adhesiolysis. The next step was to dissect and divide the right hepatic artery and the right portal vein. A retrohepatic tunnel is created on the right side of the inferior vena cava for a modified liver hanging maneuver. The liver was pulled upwards and liver transection resumed towards the right hepatic vein. The liver was divided with bipolar forceps under continuous saline irrigation. The right hepatic duct was found inside the liver and was divided. Finally, the right hepatic vein was divided inside the liver parenchyma using a vascular stapler, and robotic right hepatectomy was completed. RESULTS: The operative time for docking was 10 min; adhesiolysis took 90 min while robotic right hepatectomy was completed in 240 min. The Pringle maneuver was not used. Estimated blood loss was 150 mL with no need for transfusion. Recovery was uneventful, and the patient was discharged on the fifth postoperative day. CONCLUSIONS: Robotic repeat hepatectomy is feasible and safe in experienced hands and may have some advantages over laparoscopic and open repeat liver resections.
BACKGROUND: Repeat hepatectomy often is required for primary and metastatic tumors. The purpose of this video was to present a robotic repeat hepatectomy for recurrent colorectal metastasis after multiple previous open surgeries. PATIENT: A 64-year-old man underwent open left colectomy complicated by anastomotic leak. He was reoperated for colostomy, which was reverted. One year later, he underwent open metastasectomy. Recently, he presented a recurrence in the right liver, and a robotic right hepatectomy was indicated. TECHNIQUE: This approach used five trocars. The operation began with adhesiolysis. The next step was to dissect and divide the right hepatic artery and the right portal vein. A retrohepatic tunnel is created on the right side of the inferior vena cava for a modified liver hanging maneuver. The liver was pulled upwards and liver transection resumed towards the right hepatic vein. The liver was divided with bipolar forceps under continuous saline irrigation. The right hepatic duct was found inside the liver and was divided. Finally, the right hepatic vein was divided inside the liver parenchyma using a vascular stapler, and robotic right hepatectomy was completed. RESULTS: The operative time for docking was 10 min; adhesiolysis took 90 min while robotic right hepatectomy was completed in 240 min. The Pringle maneuver was not used. Estimated blood loss was 150 mL with no need for transfusion. Recovery was uneventful, and the patient was discharged on the fifth postoperative day. CONCLUSIONS:Robotic repeat hepatectomy is feasible and safe in experienced hands and may have some advantages over laparoscopic and open repeat liver resections.