ROBOTIC LEFT HEPATECTOMY PLUS LOCO-REGIONAL LYMPHADENECTOMY FOR MALIGNANCY USING THE DA VINCI XI

Background: Major hepatectomies are challenging procedures when performed in a minimally invasive fashion. The robotic approach makes some surgical maneuvers easier respect to laparoscopy, thanks to its technological advantages. We present a case of left hepatectomy and local lymphadenectomy for hepatocellular carcinoma, performed with the da Vinci System. Methodology: A 72-years old man with HBV chronic infection and imaging finding of a 4-cm solid neoplasia of the left hepatic lobe, was operated with the da Vinci Xi platform. The patient was placed in a supine position, with 15° anti-Trendelenburg inclination. The trocars were positioned in a peri-umbelical rectilinear line. Results: The procedure was successfully completed in 360 min. Firstly, thanks to Tile-Pro technology, an intra-operative US scan was performed to determinate the tumor extension and to clearly define the hepatic anatomy and the correct plane. The hepatic transaction was then performed with monopolar scissors and bipolar Maryland grasps. The left portal and arterial pedicle were sealed with Hem-o-lok whereas the left hepatic vein was sealed using an endoscopic vascular stapler. No conversion to laparoscopy or laparotomy was needed and no surgical complications were registered. The postoperative course was uneventful and the patient was discharged 5 days after surgery. Conclusion: The robotic surgery presents intrinsic advantages related to its 3D view and to the instruments’ seven degrees of motion. The da Vinci Xi has brought further improvements related to its easier docking phase and maneuverability. In addition, the possibility to integrate US imaging with surgical field, directly controlled by the operating surgeon, gives the possibility to clearly define the hepatic anatomy and the correct surgical plane.