Robotic left lateral sectionectomy for hepatocellular carcinoma (HCC) on cirrhotic liver

Abstract

Purpose: We present the case of a 82 years-old patient affected by HCV liver fibrosis with a diagnosis of a single resectable 2cm HCC of the superior border of segment II. The patient underwent a robotic left lateral sectionectomy. Method: Pre-operative work-up included liver MRI, thoracic CT-scan and blood exams. Child-Pugh score A5, MELD score 8, Platelet count normal, AFP within normal values. Gastroscopy was normal. After multidisciplinary discussion a liver resection was indicated using a robotic minimally invasive approach. Results: During intraoperative ultrasound, after excluding other missed lesions, careful evaluation of the tumor is done in order to precise the relationship with the terminal part of the left hepatic vein. Kelly clamp crushing technique is performed with assistant driven irrigation of the instrument. When dissection needs to be more precise an original use of cavitron ultrasonic surgical aspirator (CUSA), introduced in the assistant trocar and guided by the robotic arm. Final section of the hepatic vein is made with scissors after vascular clamping. A double 5/0 polypropilene running suture is performed to close the venous stump. The specimen is then extracted by a Pfannenstiel incision. There were no intraoperative complications, the post-operative course was uneventful with patient discharged at POD 4.Pathological findings: pT1 well-differentiated hepatocellular carcinoma (Edmonson-Steiner grade 1), with no vascular invasion, R0 (complete resection). Conclusion: Robotic liver resection allows a precise dissection, vascular suturing is more ergonomic because of the articulating instruments tip.