Ishikawa Takuma, Itoh Shinji, Toshima Takeo, Yoshiya Shohei, Bekki Yuki, Iseda Norifumi, Tsutsui Yuriko, Sakamoto Ichiro, Abe Kotaro, Yoshizumi Tomoharu
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1 Maidashi, Higashi-Ku, Fukuoka-Shi, Fukuoka, 812-0054, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Surg Case Rep. 2024 Sep 9;10(1):210. doi: 10.1186/s40792-024-02014-5.
Fontan-associated liver disease (FALD) encompasses hepatic complications following the Fontan procedure, ranging from fibrosis to hepatocellular carcinoma (HCC). Despite advancements in surgical techniques and perioperative care, robot-assisted laparoscopic hepatectomy (RALH) for HCC in patients with FALD has not been previously reported owing to concerns about the Fontan circulation.
We present the first case of RALH for recurrent HCC in a 45-year-old man after the Fontan procedure. The preoperative evaluation confirmed good cardiac function. The procedure involved meticulous monitoring and management of central venous pressure and was successfully completed with minimal blood loss. Postoperative recovery was uneventful. With thorough preoperative cardiac assessment and close collaboration between cardiologists and anesthesiologists, RALH can be safely performed in selected patients with FALD.
Even if a patient has a history of FALD, RALH can be safely performed in selected patients under appropriate conditions.
Fontan相关肝病（FALD）包括Fontan手术后继发的肝脏并发症，范围从纤维化到肝细胞癌（HCC）。尽管手术技术和围手术期护理取得了进展，但由于担心Fontan循环，此前尚未报道过针对FALD患者的HCC进行机器人辅助腹腔镜肝切除术（RALH）。
我们报告了首例Fontan手术后45岁男性复发性HCC行RALH的病例。术前评估证实心脏功能良好。手术过程中对中心静脉压进行了细致监测和管理，手术成功完成，失血极少。术后恢复顺利。通过全面的术前心脏评估以及心脏病专家和麻醉专家之间的密切合作，RALH可以在选定的FALD患者中安全进行。
即使患者有FALD病史，在适当条件下，选定的患者也可以安全地进行RALH。
