FULL ROBOTIC LEFT SECTIONECTOMY PARTIALLY EXTENDED TO THE FOURTH SEGMENT FOR LEFT BILE DUCT CHOLANGIOCARCINOMA

Aims: The da Vinci robotic technology, particularly the Xi system, can improve and simplify challenging minimally invasive abdominal procedures such as major hepatectomies. Indeed, 3D magnified vision, Endowrist instruments and robotic staplers can be valuable tools to reduce blood loss and biliary leakage during the hepatic parenchyma dissection. We present a case of a full robotic left sectionectomy partially extended to the fourth segment, for left bile duct cholangiocarcinoma carried out with the da Vinci Xi system. Methods: A 72-years old woman with a finding of alteration of cholestasis enzymes was referred to our center. A CT scan showed a 7x4 mm contrast enhancement in the left hepatic duct, with a consensual dilatation of left intrahepatic biliary ducts, referring to a left bile duct cholangiocarcinoma. Thus, she underwent a robotic left sectionectomy partially extended to the fourth segment, with the da Vinci Xi platform. The patient was placed in a supine position, with anti-Trendelemburg 15° inclination. The trocars were positioned according to the upper quadrants trocars’ position suggested by Intuitive. Results: The procedure was successfully completed in 255 min. The hepatic parenchyma transection was performed with bipolar grasps and the left hepatic vein was transected with a robotic vascular stapler. No intra-operative complications occurred. The post-operative course was uneventful and the patient was discharged 5 days after surgery. Conclusion: The da Vinci Xi platform can improve the exposure and the dissection maneuvers during minimally invasive hepatic surgery. The dexterity of robotic manipulation can simplify the dissection of hepatic parenchyma and the 3D magnified vision may help to recognize the structures of hepatic parenchyma and of hepatic hilum.