Robotic Resection of Postero-Superior Liver Segments (7,8) (with Video)
- PDF / 153,600 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 39 Downloads / 145 Views
MULTIMEDIA ARTICLE
Robotic Resection of Postero-Superior Liver Segments (7,8) (with Video) Marcel Autran C. Machado 1
&
Bruno H. Mattos 1 & Murillo M. Lobo Filho 1 & Fabio F. Makdissi 1
Received: 1 August 2020 / Accepted: 6 September 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Surgical resection is the standard treatment for colorectal liver metastases. Parenchyma-sparing technique should always be attemptedto prevent postoperative liver failure and increase the opportunity to perform repeated resections in cases of recurrent malignancy. Postero-superior liverresection is defined as the anatomical removal of liver segments 7 and 8, however, minimally invasive resection of postero-superior liver segments isconsidered a difficult and complex operation and thus is rarely reported. Methods We present the video of a robotic postero-superior liver resection in a 54-year-old male patient with a synchronous, single, and large colorectal metastasis in the postero-superior liver sector. The Da Vinci Xi system was used. The right liver was mobilized with exposure of the inferior vena cava (IVC), following by intraoperative ultrasound, used to locate the tumor and establish its relationship to the right hepatic vein and portal pedicles fromsegments 7 and 8. A thick hepatic vein draining directly to the IVC was controlled with hem-o-lock and the right hepatic vein was divided using anendoscopic stapler. The surgical specimen was removed through a supra-pubic incision. Results Operative time was 205 minutes, and the estimated blood loss was 310 mL. The patient's recovery was uneventful with no need for admission tothe intensive care unit or for blood transfusion. Pathology confirmed colorectal metastasis with free surgical margins.Conclusions: Robotic resection of postero-superior liver segments is feasible and safe and may have some advantages over laparoscopic and openapproaches. This video may help gastrointestinal surgeons perform this complex procedure. Keywords robotic . liver . postero-superior segments
Surgical resection is the standard treatment for colorectal liver metastases. Interventions should always attempt to preserve liver parenchyma to prevent postoperative liver failure and increase the opportunity to perform repeated resections in cases of recurrent malignancy. A better knowledge of liver anatomy and the use of intraoperative ultrasound have provided the basis for segmental liver resection. Postero-superior liver resection or bisegmentectomy 7–8 is defined as the
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04799-w) contains supplementary material, which is available to authorized users. * Marcel Autran C. Machado [email protected] 1
Nove de Julho Hospital, Rua Dona Adma Jafet 74 cj 102, São Paulo 01308-050, Brazil
anatomical removal of liver segments 7 and 8. However, until recently, this type of operation was considered only for patients with a large accessory right hepatic vein, but further studies con
Data Loading...
