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Journal of Robotic Surgery

, Volume 12, Issue 3, pp 549–552 | Cite as

Robotic left lateral sectionectomy as stepwise approach for cirrhotic liver

  • Raphael L. C. AraujoEmail author
  • Luís Antônio de Castro
  • Fernando E. C. Fellipe
  • Diego Burgardt
  • Durval R. Wohnrath
Case Report

Abstract

Laparoscopy is considered the gold standard approach to perform left lateral sectionectomy (LLS). Furthermore, laparoscopy for cirrhotic patients can reduce intraoperative bleeding and postoperative morbidity when compared to open surgery. Although robotic surgery is feasible for both minor and major liver resections, it remains a work in progress and only few series reported this approach for cirrhotic patients. We reported two cases of 62-year-old men, both with hepatitis C virus and alcoholic cirrhosis, but with compensated liver functions (MELD 9–10 and Child–Pugh A5–A6). The patients were diagnosed with a single lesion in the left lobe. Robotic LLS was performed using intraoperative ultrasound to confirm findings of pre-operative image, and linear staplers were used to control left lobe inflow and outflow. The specimens were removed through Pfannenstiel incision in both patients. Both procedures followed the same standardization. The total operative time was 250 and 151 min with estimated blood loss of 100 and 70 ml, respectively, for cases 1 and 2. The procedures were made without Pringle maneuver and postoperative course was uneventful with hospital discharge at third and fourth postoperative day, respectively. The pathology examination confirmed a 2.5- and 4.5-cm hepatocellular carcinoma, respectively; both presented negative margins and cirrhosis. Robotic LLS seems to be as feasible as conventional laparoscopic approach as a stepwise procedure in a robotic learning curve for liver resection. Its benefits can also be offered to selected cirrhotic patients.

Keywords

Hepatocellular carcinoma Liver cirrhosis Robotics Minimally invasive surgery Hepatectomy 

Abbreviations

MIS

Minimally invasive surgery

HCC

Hepatocellular carcinoma

LLS

Left lateral sectionectomy

MELD

Model of end-stage liver disease

Notes

Compliance with ethical standards

Funding

This paper was not funded in part or in whole by any organization.

Conflict of interest

All authors declare that they have nothing to disclose.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Consent section

Written informed consent was obtained from the patient for publication of these Case Reports and any accompanying images.

Supplementary material

11701_2017_730_MOESM1_ESM.mp4 (229.1 mb)
Supplementary material 1 (MP4 234602 kb)

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Copyright information

© Springer-Verlag London Ltd. 2017

Authors and Affiliations

  • Raphael L. C. Araujo
    • 1
    Email author
  • Luís Antônio de Castro
    • 2
  • Fernando E. C. Fellipe
    • 1
  • Diego Burgardt
    • 1
  • Durval R. Wohnrath
    • 1
  1. 1.Department of Upper Gastrointestinal and Hepato-pancreato-biliary SurgeryBarretos Cancer HospitalBarretosBrazil
  2. 2.Department of Interventional RadiologyBarretos Cancer HospitalBarretosBrazil

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