ROBOT-ASSISTED LEFT EPATECTOMY WITH THE DA VINCI XI

Background: Minimally invasive hHepatobiliary procedures using a minimally invasive approach are challenging, especially major hepatectomies. The use of da Vinci Ssurgical System, particularly the Xi version, has been developedallows to overcome some of the kinematics limitations of the direct manual laparoscopy, with potential maintaining the potential advantages of a minimally invasieve approach apporachs 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. Methodsology: 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, underwent surgerywas operated with the da Vinci Xi platform. The patient was placed in a supine position, with 15° anti-Trendelenburg 15° inclination. The trocars' were positioned used is that for according with the Intuitive indication for the upper quadrants surgery suggested by Intuitive. Results: The procedure was successfully completed in 360 min. FirstlyAt first, an intraoperative US scan with the use of Tile-Pro technology was done to determinate the tumor extension. The hepatic parenchyma transaection and the local lymphadenectomy were performed with monopolar scissors and bipolar grasps. The left hepatic vein section was transactedmed with an endoscopic vascular stapler. NThere were no intraoperativesurgical complications or need for conversion to laparoscopy or laparotomy were recorded. The post-operative course was uneventful and the patient was discharged 5 days after surgery. Conclusion: In our experience, tThe da Vinci Xi system couldcan offer facilitate some technically demanding procedures, allowing an easier timately widen the range of application of minimally invasive major hepatic surgery such as an improved dexterity in minimally invasive 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.; Ffurthermore, In particular, it makes it easier thanks to the endo-wrist technology that simplify dissection and vascular control. 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.to identify anatomical structures and their relationship with the tumor.