ROBOTIC LEFT HEPATECTOMY AND REGIONAL LYMPHADENECTOMY WITH DA VINCI XI FOR HEPATOCELLULAR CARCINOMA

Background: The da Vinci surgical System has been developed to overcome some of the kinematics limitations of the direct manual laparoscopy, with potential advantages in particular in challenging abdominal procedures, such as the hepatobiliary ones. 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-year 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 anti-Trendelemburg 15° inclination. The trocars' position used is that for the upper quadrants suggested by Intuitive. 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 tumor extension. The hepatic parenchyma transection and 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: In our experience, the da Vinci Xi can offer some advantages in minimally invasive hepatic surgery by facilitating exposure, dissection and reducing blood loss. In particular, the dexterity of intra-corporeal robotic manipulation may simplify the deep dissection into the hepatic parenchyma, thus keeping the correct resection plane. Furthermore, the Tile-Pro multi-input display allows the surgeon a 3D view of the operative field along with ultrasound exam to identify anatomical structures and their relationship with the tumor.