Robotic left hepatectomy for colorectal liver metastases with modified rubber-band technique: surgical technique & steps

摘要

Minimally invasive liver surgery has had slower uptake compared to other organ systems over the years, due to complex three-dimensional anatomy, risk of intraoperative bleeding, and the associated steep learning curve.The consensus statements of Louisville 2009 and Morioka 2015 recommended the use of minimally invasive hepatectomy only to solitary lesions, 5 cm or less, located in segments II-VI.Over the years, with improved operative techniques, superior instruments including the robotic platform, and better perioperative care, surgeons have pushed boundaries, successfully expanded the indications, and delivered improvement in outcomes of a hitherto feared operation.The robotic platform provides unique advantages for minimally invasive hepatectomy like the magnified view with a stable camera platform and multiple degrees of instrument freedom.These advantages help improve the laparoscopic technique of hepatectomy although procedural cost is a concern.To some extent, we have been able to contain the procedure cost by using only four robotic instruments with other instruments through laparoscopic ports, without compromising on surgical ergonomics and outcomes.A modification of the rubber band technique popularized by Choi et al. is employed to improve surgical ergonomics, especially during hepatic parenchymal transection.In this article, we present a video vignette of a formal robotic left hepatectomy for colorectal liver metastases (CRLMs) with tips and tricks of the operation for easy reproducibility.Liver metastases of colorectal origin are seen in about 25-30% of patients and are addressed with surgical resection in appropriately selected cases.Our patient had a blood loss of 600 cc and a specimen weight of 420 g.The operative duration was 340 min.The postoperative course was uneventful, and the patient was discharged on the 7th postoperative day.Robotic liver resections (RLRs) are eminently feasible but have an associated learning curve, with patient selection being a key factor.