Department of Digestive Surgery, Hôpital Européen, 6 rue désirée Clary, 13003, Marseille, France.
Ann Surg Oncol. 2023 Jul;30(7):4276. doi: 10.1245/s10434-023-13272-2. Epub 2023 Mar 22.
Liver resection is indicated for resectable liver metastases of neuroendocrine tumors. Minimally invasive liver resection offers decreased blood loss, reduces pain, reduces postoperative complications, and reduces time to functional recovery. However, access to posterior section remains difficult with conventional laparoscopic tools. The robotic approach could overcome these limitations.
A 46-year-old woman had a pancreatic neuroendocrine tumor with synchronous liver metastases (18 mm in segment 6, 29 mm in segment 7, and 31 mm in segment 8). Due to stable disease after 2 years of somatostatin analog treatment, surgical management was decided. The first step was robotic distal pancreatectomy. Two months later, we performed a posterior sectionectomy associated with a wedge resection in segment 8.
Da Vinci X robot was used. Surgery was conducted with a second surgeon located between the patient's legs using suction/irrigation device and ultrasonic dissector through laparoscopic ports. The posterior sectorial branches of the hepatic artery and portal vein were controlled via an intra-fascial approach. Robotic parenchymal dissection was performed by a four-hands method, with laparoscopic ultrasonic dissector and robotic irrigated bipolar guided by indocyanine green. Transection was led on the right side of right hepatic vein without clamping. Operative duration was 330 min, and estimated blood loss was 50 ml. Postoperative course was complicated by grade B biliary fistula. The patient was discharged on postoperative day 10.
This case illustrates the feasibility and safety of a robotic approach for right posterior liver sectionectomy, which can improve the dexterity of the surgeon and thus the possibility of difficult minimally invasive liver resection.
肝切除术适用于可切除的神经内分泌肿瘤肝转移灶。微创肝切除术可减少出血、减轻疼痛、减少术后并发症并缩短功能恢复时间。然而，使用常规腹腔镜工具难以进入后区。机器人方法可以克服这些限制。
一位 46 岁女性患有胰腺神经内分泌肿瘤伴同步肝转移（6 段 18mm、7 段 29mm 和 8 段 31mm）。由于生长抑素类似物治疗 2 年后疾病稳定，决定进行手术治疗。第一步是进行机器人胰远端切除术。两个月后，我们进行了后区节段切除术，并在 8 段进行楔形切除术。
使用达芬奇 X 机器人。手术由位于患者两腿之间的第二位外科医生使用抽吸/冲洗装置和通过腹腔镜端口的超声刀进行。肝动脉和门静脉后区分支通过筋膜内入路控制。机器人实质解剖采用双手法进行，腹腔镜超声刀和机器人灌洗双极通过吲哚菁绿引导。在不夹闭的情况下沿右肝静脉右侧进行横断。手术持续时间为 330 分钟，估计出血量为 50 毫升。术后病程复杂，出现 B 级胆瘘。患者术后第 10 天出院。
该病例说明机器人方法进行右后肝段切除术的可行性和安全性，这可以提高外科医生的灵巧性，从而增加微创肝切除术的可能性。
