Robot-assisted caudate lobectomy

Objective To investigate the feasibility, safety and surgical techniques of robot-assisted caudate lobectomy. Methods Clinical data of 7 patients who underwent robot-assisted caudate lobectomy in the PLA General Hospital between July 2009 and May 2012 were retrospectively analyzed. Among them, 6 cases were males and 1 female, aged 36-65 years old with a median age of 51 years old. Five cases were diagnosed with hilar cholangiocarcinoma, 1 with hepatocellular carcinoma in caudate lobe complicated with hilar cholangiocarcinoma thrombus, and 1 with intrahepatic cholangiocarcinoma. The informed consents of all patients were obtained and the local ethical committee approval was received. Six Trocars were created at the abdominal wall and the da Vinci surgical system (DVSS) was implanted. The caudate lobectomy was performed without occlusion of hepatic blood inflow by Pringle method. Results Except 1 patient underwent surgery with Hybrid, the other 6 patients successfully underwent surgery only with DVSS. No conversion to laparotomy was observed. Among the surgery, 4 cases were combined with right lobe resection, 2 cases with left lobe resection and 1 case with extented right hepatectomy. The median operation time was 694(600-720) min. The blood loss was 1 360(400-3 000) ml. Five cases received blood transfusion during surgery. One case died of liver failure 18 d after surgery. Postoperative complications were observed in 4 patients. Among them, 2 cases of bile leakage and 1 of bile leekage complicated with deep venous thrombosis in the lower extremity were all cured after conservative therapy, and 1 case of hemorrhage caused by ruptured hepatic artery aneurysm 2 d after surgery was cured by open resection and reconstruction of aneurysm. The postoperative length of hospital stay was 15(9-19) d. Conclusions Robot-assisted caudate lobectomy is safe and feasible, which broadens the indications of laparoscopic hepatactomy and is beneficial to precise hilar dissection and laparoscopic suture, especially for caudate lobectomy of hilar cholangiocarcinoma. Key words: Bile duct neoplasms; Robotics; Hepatectomy; Liver lobectomy; Hilar cholangiocarcinoma