Robotic right hepatectomy for giant hepatocellular adenoma - With video

Background: The safety and efficiency of mini-invasive approach for liver resection have been confirmed. However, laparoscopic approach suffers from several limits due to technical difficulties particularly for voluminous tumor. Robotic approach could improve accessibility of these difficult tumors. Methods: A 29-year-old woman was treated for a giant telangiectasic adenoma [1] of the right liver measuring 20 cm. Results: A robotic anatomical right hepatectomy was decided [2]. Da Vinci X robot was used. The procedure was performed with a second surgeon positioned between the patient's legs using suction/irrigation device and ultrasonic dissector through laparoscopic ports [3]. A first hilar approach allows individualization of right hepatic artery and portal vein. Robotic irrigated bipolar coagulation and laparoscopic ultrasonic dissector was used for parenchymal transection. Operation time was 290 min, and estimated blood loss was 150 ml. Postoperative course was uneventful. The patient was discharged on postoperative day eight. Conclusions: Robotic approach could improve accessibility to minimally invasive liver resection of voluminous tumor.