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Annals of Surgical Oncology

, Volume 26, Issue 1, pp 292–295 | Cite as

Robotic Repeat Right Hepatectomy for Recurrent Colorectal Liver Metastasis

  • Marcel Autran MachadoEmail author
  • Rodrigo C. Surjan
  • Tiago Basseres
  • Fabio Makdissi
Hepatobiliary Tumors
  • 69 Downloads

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.

Supplementary material

10434_2018_6996_MOESM1_ESM.mp4 (137 mb)
Supplementary material 1 (MP4 140317 kb)

References

  1. 1.
    Shafer Z, Kazaryan AM, Marvin MR, et al. Is laparoscopic repeat hepatectomy feasible? A tri-institutional analysis. J Am Coll Surg. 2011;212:171–9.CrossRefGoogle Scholar
  2. 2.
    Shelat VG, Serin K, Samim M, et al. Outcomes of repeat laparoscopic liver resection compared to the primary resection. World J Surg. 2014;38:3175–80.CrossRefGoogle Scholar
  3. 3.
    Isetani M, Morise Z, Kawabe N, et al. Pure laparoscopic hepatectomy as repeat surgery and repeat hepatectomy. World J Gastroenterol. 2015;21:961–8.CrossRefGoogle Scholar
  4. 4.
    Noda T, Eguchi H, Wada H, et al. Short-term surgical outcomes of minimally invasive repeat hepatectomy for recurrent liver cancer. Surg Endosc. 2018;32:46–52.CrossRefGoogle Scholar
  5. 5.
    Rubbia-Brandt L, Giostra E, Brezault C, et al. Importance of histological tumor response assessment in predicting the outcome in patients with colorectal liver metastases treated with neo-adjuvant chemotherapy followed by liver surgery. Ann Oncol. 2007;18:299–304.CrossRefGoogle Scholar
  6. 6.
    Butte JM, Gönen M, Allen PJ, et al. Recurrence after partial hepatectomy for metastatic colorectal cancer: potentially curative role of salvage repeat resection. Ann Surg Oncol. 2015;22:2761–71.CrossRefGoogle Scholar
  7. 7.
    Ciria R, Cherqui D, Geller DA et al. Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg. 2016;263:761–77.CrossRefGoogle Scholar
  8. 8.
    Belli G, Cioffi L, Fantini C, et al. Laparoscopic redo surgery for recurrent hepatocellular carcinoma in cirrhotic patients: feasibility, safety, and results. Surg Endosc. 2009;23:1807-11.CrossRefGoogle Scholar
  9. 9.
    Machado MA, Surjan RC, Basseres T, et al. The laparoscopic Glissonian approach is safe and efficient when compared with standard laparoscopic liver resection: results of an observational study over 7 years. Surgery. 2016;160:643-51.CrossRefGoogle Scholar
  10. 10.
    Wong DJ, Wong MJ, Choi GH et al. (2018) Systematic review and meta-analysis of robotic versus open hepatectomy. ANZ J Surg.  https://doi.org/10.1111/ans.14690.Google Scholar
  11. 11.
    Giulianotti PC, Sbrana F, Coratti A, et al. Totally robotic right hepatectomy: surgical technique and outcomes. Arch Surg. 2011;146:844-50.CrossRefGoogle Scholar
  12. 12.
    Tsung A, Geller DA, Sukato DC, et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg. 2014;259:549-555.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Marcel Autran Machado
    • 1
    • 2
    Email author
  • Rodrigo C. Surjan
    • 1
    • 2
  • Tiago Basseres
    • 2
  • Fabio Makdissi
    • 2
    • 3
  1. 1.Department of SurgeryUniversity of São PauloSão PauloBrazil
  2. 2.Nove de Julho HospitalSão PauloBrazil
  3. 3.Department of GastroenterologyUniversity of São PauloSão PauloBrazil

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