Robotic Extended Right Hepatectomy for Colorectal Liver Metastasis

Background Advantages of minimally invasive compared with open hepatobiliary surgery include quicker functional recovery, decreased postoperative length of stay, and decreased postoperative opioid use. As more complex operations are approached in minimally invasive fashion, it is imperative to maint...

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Bibliographic Details
Published in:Annals of surgical oncology 2022-12, Vol.29 (13), p.8455-8455
Main Authors: Newton, Andrew D., Newhook, Timothy E., Ikoma, Naruhiko, Tzeng, Ching-Wei D., Chun, Yun Shin, Vauthey, Jean-Nicolas, Tran Cao, Hop S.
Format: Article
Language:English
Subjects:
Hepatectomy
Hepatobiliary Tumors
Liver
Medicine
Medicine & Public Health
Metastases
Metastasis
Oncology
Parenchyma
Recovery of function
Robotic surgery
Surgery
Surgical Oncology
Tumors
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Summary:Background Advantages of minimally invasive compared with open hepatobiliary surgery include quicker functional recovery, decreased postoperative length of stay, and decreased postoperative opioid use. As more complex operations are approached in minimally invasive fashion, it is imperative to maintain safety and excellent oncologic outcomes. Methods In this video, we demonstrate the key principles in performing a safe robotic extended right hepatectomy for colorectal liver metastasis following sound oncologic principles. Results Key preoperative considerations include (1) early referral to a hepatobiliary surgeon, (2) careful review of cross-sectional imaging to identify the relationship of tumors to major vasculature and any aberrant vascular anatomy, and (3) liver volumetry for every right hepatectomy to determine the need for future liver remnant volume augmentation. Key intraoperative techniques include (1) liberal use of ultrasound before and during transection to determine the relationship of major vasculature to tumor to preserve liver parenchyma without compromising tumor margins, (2) external retraction with vessel loops placed on either side of the transection line as stay sutures to facilitate parenchymal transection, and (3) a crush clamp technique to safely identify and control crossing vessels while dividing liver parenchyma. Conclusions With proper preoperative planning and intraoperative use of these techniques, the benefits of a minimally invasive approach can be achieved while maintaining excellence in surgical quality and safety.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-022-12493-1