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.