MAJOR HEPATIC SURGERY WITH THE DA VINCI XI: A ROBOT-ASSISTED LEFT HEPATECTOMY

Background: Hepatobiliary procedures using a minimally invasive approachare demanding, especially in major hepatectomies. The use of da Vinci surgical System allows to overcome some of the kinematics limitations of the direct manual laparoscopy maintaining the potential advan- tages of a minimally invasive approach . We herein present a case of left hepatectomy and local lymphadenectomy for hepatocellular carcinoma, carried out with the use of the da Vinci Xi. Methodology: A 72-years old man with a long-lasting HBV chronic infection and CT scan and MRI finding of a 4-cm solid neoplasia of the left hepatic lobe and gallbladder stones, 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 according with the Intuitive indication for the upper quadrants surgery. Results: The procedure was successfully completed in 360 min.At first, an intraoperative US scan with the use of Tile-Pro technology was done to determinate the tumor extension. The hepatic parenchyma transaction and the local lymphadenectomy were performed with monopolar scissors and bipolar grasps. The left hepatic vein section was performed with an endoscopic vascular stapler. There were no surgical complications or need for conversion to laparoscopy or laparotomy. The post-operative course was uneventful and the patient was discharged 5 days after surgery. Conclusion: The da Vinci Xi can facilitate some technically demanding procedures and ulti- mately widen the range of application of minimally invasive surgery such as hepatic surgery. Besides the well- known advantages provided by robotic surgery on 3D imaging, increased range of motion and augmented surgical dexterity, one of the most interesting and innovative features of robotic technology is the digitalization of the operative view; furthermore the Tile-Pro multi- input display allows the surgeon a 3D view of the operative field along with the ultrasound exam for a precise understanding of anatomy and vascularity and of tumor location.