Nove de Julho Hospital, Rua Dona Adma Jafet 74 cj 102, São Paulo, 01308-050, Brazil.
J Gastrointest Surg. 2021 Feb;25(2):574-575. doi: 10.1007/s11605-020-04799-w. Epub 2020 Sep 18.
Surgical resection is the standard treatment for colorectal liver metastases. Parenchyma-sparing technique should always be attemptedto prevent postoperative liver failure and increase the opportunity to perform repeated resections in cases of recurrent malignancy. Postero-superior liverresection is defined as the anatomical removal of liver segments 7 and 8, however, minimally invasive resection of postero-superior liver segments isconsidered a difficult and complex operation and thus is rarely reported.
We present the video of a robotic postero-superior liver resection in a 54-year-old male patient with a synchronous, single, and large colorectal metastasis in the postero-superior liver sector. The Da Vinci Xi system was used. The right liver was mobilized with exposure of the inferior vena cava (IVC), following by intraoperative ultrasound, used to locate the tumor and establish its relationship to the right hepatic vein and portal pedicles fromsegments 7 and 8. A thick hepatic vein draining directly to the IVC was controlled with hem-o-lock and the right hepatic vein was divided using anendoscopic stapler. The surgical specimen was removed through a supra-pubic incision.
Operative time was 205 minutes, and the estimated blood loss was 310 mL. The patient's recovery was uneventful with no need for admission tothe intensive care unit or for blood transfusion. Pathology confirmed colorectal metastasis with free surgical margins.
Robotic resection of postero-superior liver segments is feasible and safe and may have some advantages over laparoscopic and openapproaches. This video may help gastrointestinal surgeons perform this complex procedure.
手术切除是结直肠癌肝转移的标准治疗方法。应始终尝试采用保肝技术，以防止术后肝功能衰竭，并在恶性肿瘤复发时增加重复切除的机会。后上肝切除术被定义为解剖性切除肝段 7 和 8，但微创切除后上肝段被认为是一项困难且复杂的手术，因此很少有报道。
我们展示了一名 54 岁男性患者的机器人后上肝切除术的视频，该患者同时患有单个大的结直肠后上肝转移灶。使用达芬奇 Xi 系统。通过暴露下腔静脉（IVC）来游离右肝，然后进行术中超声检查，以定位肿瘤，并确定其与右肝静脉和来自第 7 和 8 段的门静脉分支的关系。用Hem-o-lock 控制直接通向 IVC 的粗大肝静脉，并使用内镜吻合器切断右肝静脉。手术标本通过耻骨上切口取出。
手术时间为 205 分钟，估计失血量为 310 毫升。患者恢复顺利，无需入住重症监护病房或输血。病理证实为结直肠转移，切缘无肿瘤。
机器人切除后上肝段是可行且安全的，并且可能比腹腔镜和开腹方法具有一些优势。这段视频可能有助于胃肠外科医生进行这一复杂的手术。
