Robotic Anatomical Segment VIII Resection for Hepatocellular Carcinoma Using the Scissor Hepatectomy Technique.

Abstract

Robotic hepatectomy has been increasingly adopted for the treatment of hepatocellular carcinoma (HCC). However, the ideal technique of parenchymal transection in robotic hepatectomy has been a matter of ongoing debate in literature. In this video, we demonstrate the technique of robotic anatomical segment VIII resection using the scissor hepatectomy technique¹ for parenchymal transection on a 75-year-old male patient with a solitary HCC lesion. The patient had viral hepatitis (chronic hepatitis B infection) with a compensated liver cirrhosis and a new solitary 40 mm lesion on cross-sectional imaging. The AFP-negative lesion was biopsied, and the diagnosis of HCC was confirmed. A primary surgery was considered by a multidisciplinary tumor conference. We performed a pure robotic segmentectomy on the DaVinci Xi-system. An intrahepatic Glissonean pedicle approach was performed. Segment VIII pedicles were accessed and taken down with clips. Parenchymal transection was performed using robotic scissors with the intermittent Pringle maneuver and indocyanine green-fluorescence guiding. The middle hepatic vein and the right hepatic vein were preserved. There was a total blood loss of 300 ml. The postoperative course was uneventful. The patient was discharged on postoperative day 6 with no signs of recurrence on 3-month follow-up. Robotic anatomical resection of segment VIII using the scissor hepatectomy technique is safe and feasible. Prospective studies are warranted to compare robotic parenchymal transection techniques using various devices.