Robotic Anatomic Isolated Complete Caudate Lobectomy: Left-Side Approach And Techniques

Background: To demonstrate the surgical procedures and techniques of the robotic anatomical isolated complete caudate lobectomy.Methods: A retrospective analysis was performed on the demographic, operative, postoperative outcomes of seven patients who underwent robotic anatomical isolated complete caudate lobectomy at our department from January 2018 to November 2019. Mobilization of the left lateral and Spiegel lobe, dissection of the short hepatic veins and liver parenchyma transection from the dorsal plane of middle and right hepatic vein were crucial procedures for the robotic left-side approach. Anatomic complete caudate lobectomy was defined as total removal of the caudate lobe, in which the dorsal middle and right hepatic vein, the inferior vena cava and its right side were fully exposed on the raw surface.Results: All patients successfully underwent the robotic anatomical isolated caudate lobectomy with a left-side approach without conversion to laparotomy, and without Clavien-Dindo Grade III or higher complications. The average tumor diameter was 65.00 +/- 10.61 mm, the average operation time was 212.00 +/- 74.53 min, the median bleeding loss was 100 mL, and the average postoperative hospital stay was 8.71 +/- 4.89 d, respectively. There were four patients with primary hepatocellular carcinoma, one with tumor recurrence five months after surgery and three patients were free of recurrence. All patients survived at the last follow-up.Conclusion: Robotic anatomical isolated complete caudate lobectomy with a left-sided approach is safe and feasible for selected patients. (C) 2020 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V.