Robotic redo hepatectomy: resection SG 4B seven years after open right hemihepatectomy

Abstract

Purpose: Evidence shows that repeat liver resection is often the best treatment option for recurrent colorectal liver metastases. Although repeat resections can be complex due to adhesion and altered liver anatomy, laparoscopic liver resection has been shown to be feasible in selected patients, and has been associated with shorter operative time, less blood loss, and shorter hospital stay. Compared to laparoscopy, robotic liver surgery has the advantage of 3D visualization and a larger range of motion thanks to endowrist technology. This video aims to demonstrate the experience of a hepatopancreaticobiliary surgeon with robotic redo hepatectomy. Methods: This report describes a robotic segment 4B resection, seven years after open right hemihepatectomy, in a patient with a solitary colorectal liver metastasis. Surgical risk was assessed by the Southampton laparoscopic liver resection difficulty score, and was classified as extremely high-risk. The patient was placed in supine position with 12 degrees anti-Trendelenburg. Four robotic 8 mm ports were placed, and one assistant 12 mm port. Extensive adhesiolysis was performed with monopolar scissors and a bipolar sealing device. Intraoperative ultrasound was used to demarcate the transection line. The Pringle maneuver was applied by the Huang loop technique. Liver parenchyma transection was done by a bipolar sealing device. Locking polymer clips, hemostatic matrix and fibrillar absorbable haemostat were used to counter blood loss. Results: The Pringle maneuver was performed for 18 minutes. Operative time was 170 minutes, and blood loss was 30 cc. Pathology confirmed a R0 resection of the colorectal liver metastasis. There were no intraoperative complications encountered. The postoperative course was uneventful, and the patient was discharged on postoperative day 2. Conclusion: Robotic redo hepatectomy is feasible after previous open extensive liver surgery for repeat metastatic liver disease in selected patients.