TRANS-COLOSTOMY CLOSURE - ROBOTIC LIVER METASTASES RESECTION IN A PATIENT WITH PREVIOUS GENERALIZED PERITONITIS

Background: The minimally invasive approach is gaining widespread agreement also in the field of liver surgery. Robotic surgery can overcome some of the limitations of laparoscopy liver surgery in particular in cases of multiple localization e difficult location. We present an unusual application of robotic surgery in the field of liver surgery: a trans-colostomy closure-robotic liver metastases resection in a patient with previous generalized peritonitis with the da Vinci Si surgical system. Methods: A 67-years old man underwent anterior rectal resection for rectal carcinoma complicated by anastomotic leak and generalized peritonitis which required a re-laparotomy with peritoneal toilette, leakage repair and colostomy. A CT scan performed three months after surgery showed multiple liver metastases. The patient underwent chemotherapy with evidence of liver disease regression. The patient underwent a combined procedure of colostomy closure and contextual liver metastases resection with da Vinci Si surgical system. Results: The procedure was successfully completed in 495 min. A peristomal, right subcostal incision was made to close the colostomy. This incision was then used to the positioning of two robotic trocars through a GelPort device. The resection of liver metastases (III and VI hepatic segments) was then easily performed after an intraoperative US scan, despite the presence of intense adhesions due to the previous surgery. No surgical complications or need to conversion to laparoscopy or laparotomy occurred. The postoperative course was uneventful and the patient was discharged from hospital after 8 days. Conclusions: In our experience, the da Vinci System can offer some advantages in minimally invasive hepatic surgery, particularly in complex re-operative cases by facilitating exposure and dissection into the hepatic parenchyma.