AB030. SOH22ABS176. Robotic right hepatectomy for management of central colorectal liver metastases

Background: Oligometastatic colorectal cancer is increasingly treated with an aggressive multimodal approach, and recent data including the JCOG0603 trial highlight the central role of hepatectomy for colorectal liver metastases (CRLM). Minimally-invasive approaches to major hepatectomy have been recently described, with potential advantages in terms of postoperative pain and recovery of health-related quality of life.

Methods: We present the case of a 72-year-old female who presented with a surveillance-detected interval segment VIII liver metastasis 18 months following previous open right hemicolectomy for an adenocarcinoma of the ascending colon. The lesion measured 4.9 cm in maximum diameter and was centrally located, abutting the bifurcation of the right main portal vein.

Results: Robotic right hepatectomy was performed using da Vinci™ Surgical Robot (Intuitive Surgical, Inc., CA, USA). Intraoperative ultrasound (IOUS) was utilised to for lesion localisation and surgical margin assessment. A five-port approach was used, with initial Glissonean pedicle isolation and ligation with haemolocks. Central venous pressure was maintained at <6 mmHg during parenchymal transection, which was achieved using the Vessel Sealer Extend. A Veriset™ Hemostatic Patch (Medtronic, UK) utilised for additional haemostasis, and the specimen was extracted via a Pfannenstiel incision. The patient made an uncomplicated postoperative recovery.

Conclusions: Robotic right hepatectomy is a safe and feasible alternative to laparoscopic and open surgery for management of CRLM. Increased dexterity and enhanced 3D vision with the da Vinci™ platform may be advantageous for Glissonean pedicle isolation and transection, while IOUS can be achieved using a standard assistance port.

Keywords: Robotic; minimally invasive surgery (MIS); hepatectomy; hepatobiliary; liver