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ID: 332 (Conflict of Interest: K)

Robotisch-assistierte Major-Leberresektion – Technische Aspekte

J.Pratschke, W.Schöning, M.Schmelzle
Charité - Universitätsmedizin Berlin - CVK, Berlin

Einleitung

A structured program for the development of robotic-assisted liver surgery was established at our department in 2019. We here report on experiences gained during the course of twenty major liver resections with the Da Vinci Xi Surgical System (Intuitive Surgical Inc.).

Material und Methoden

We here present a representative video of left-sided robotic assisted hemihepatectomy in in a patients with a biliary cystadenoma. Presented intraoperative strategies and techniques represent the current standard in robotic-assisted major liver resections at our center.

Ergebnisse

We report on a 36–year old patient with an 85mm large biliary cystadenoma of the left liver lobe. A robotic-assisted left hemihepatectomy was performed using the Da Vinci Xi Surgical System. The operation was performed in 7-trocar technique with four 8mm Da Vinci trocars, one 5mm and two 12mm assist trocars. After mobilization of the left lobe of the liver, the left hepatic artery and the left portal branch were selectively displayed and transected between clips. Under repetitive sonographic control, the parenchymal dissection was performed using an ultrasound scissor. Crossing intraparenchymal structures were selectively displayed and transected. The left hepatic duct was visualized at an early stage and selectively transected between clips. The parenchymal transection was performed in the sense of a caudal approach with the transection of the left hepatic as the last step. The specimen was retrieved in a bag via a median transumbilical mini-incision. The operation time was 4.59 hours. There were no postoperative complications, allowing to discharge the patient on postoperative day 6.

Schlussfolgerung

Experiences made in complex laparoscopic liver surgery can be safely translated to robotic-assisted liver surgery. Possible advantages of robotic-assisted liver surgery over laparoscopic surgery are most evident in the selective preparation of lymph nodes and hilar structures.