First ALPPS procedure using a total robotic approach

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• 作者：E. Vicente ; Y. Quijano ; B. Ielpo ; ^{Ielpo.b@gmail.com} ; I. Fabra
• 关键词：ALPPS ; Robotic surgery ; Hepatectomy
• 刊名：Surgical Oncology
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：25
• 期：4
• 页码：457
• 全文大小：142 K
• 卷排序：25

文摘

ALPPS procedure is gaining interest. Indications and technical aspects of this technique are still under debate [1].Only 4 totally laparoscopic ALPPS procedures have been described in the literature and none by robotic approach 2, 3 and 4. This video demonstrates the technical aspects of totally robotic ALPPS.MethodsA 58 year old man with sigmoid adenocarcinoma with multiple right liver metastases extended to segment IV and I underwent Xelox and 5 Fluoro-uracil neoadjuvancy. Preoperative CT volumetric scan showed a FLR/TLV (Future Liver Remnant/Total Liver Volume) of 28%. ALPPS totally robotic procedure was planned using the DaVinci Si.ResultsTumor resection from the FLR (including segment I) is followed by parenchymal transection between the FLR and the diseased part of the liver with concomitant right portal vein ligation. Small branches to segment IV from left portal vein have been resected along the round ligament, at this step. The right biliary tract was resected as it was partially debilitated after its dissection as partially encircled by a metastasis at segment IV.Second stage was performed totally robotic on 13th postoperative days with a FLR/TLV of 40%. No strong adherences are found, making this stage much easer than open approach.During this step, right hepatic artery and right supra hepatic vein are resected. Finally, the specimen was retrieved inside a plastic bag through a Pfannenstiel incision.Postoperative pathology showed margins free from disease.ConclusionsALPPS procedure performed by robotic approach could be a safe and feasible technique in experienced centers with advanced robotic skills.