Robotic liver segmentectomy

We present the case of a robotic approach to a single metachronous colorectal liver metastasis in segment 3. Surgical technique: We have the Da Vinci Xi robot with an integrated TruSystem 7000dV OR stretcher. Patient in antitrendelenburg position at 20º. The robot is introduced from the left and the first assistant and the scrub nurse stand on the right. Pneumoperitoneum with Veress Needle. Six trocars, four 8 mm robotic and one 12 mm accessory, were placed in the right upper quadrant and another 15 mm at the suprapubic level to extract the specimen. The 30º optics. We perform intraoperative ultrasound. Next we place a tape to perform an extracorporeal Pringle. We performed the liver transection with a monopolar and bipolar scalpel and we used Hem-o-lok for pedicles and large caliber vessels. During the transection we were guided by the ultrasound to identify portal pedicles, vessels and to delineate the tumor lesion. In addition we also use indocyanine green. The transection completes without incident. We place hemostatic agent in the resection bed. We do not leave drainage. Results: The surgical time was 130 minutes. There were no complications. Discharge on the second day without incident. Discussion: The 3D vision that the robot provides for liver surgery is very useful, since it gives us a feeling of depth, stability and magnifies and improves the image. On the other, it also provides great ergonomics and maneuverability. Conclusions: Robotic liver surgery is a useful and safe tool for patients in certain resections.