Robotic fenestration of massive liver cysts using EndoWrist technology

Abstract

Background We present the short‐term outcomes of robotic fenestration of symptomatic liver cysts using the EndoWrist One Vessel Sealer. Methods Data from patients who underwent robotic deroofing were collected and analysed retrospectively. Results A total of 17 patients were treated. Mean cyst size was 14 cm (median 15 cm, range 6.3‐24). Seven cysts were in posterosuperior or central segments. There were no mortalities or conversions. Blood loss was minimal in all but one case of 200 ml. Mean operating time was 174 minutes (median 170 min, range 97‐335). Mean hospital stay was 2.5 days (median 2 days, range 1‐10). One patient developed a bile leak requiring ERCP. There are no recurrences with a median follow‐up of 19 months. Conclusion Robotic fenestration can be safely performed and offers distinct advantages over the laparoscopic approach in the treatment of posterosuperior and perihilar cysts at the expense of longer operating times and increased cost.

Avoidance of bile duct injury during laparoscopic liver cyst fenestration using indocyanine green: A case report

“…26 Since the first report of LF for liver cysts in 1991, 11,12 this procedure has been used as the standard method, although it has the risk of postoperative bile leakage. 16 In addition to various liver function tests, ICG tests are generally performed to evaluate the safety of hepatectomy, and these tests are also adopted, for example, as criteria for assessing the degree of liver damage. The ICG test was introduced and popularized by Makuuchi et al in the 1980s, especially in patients with hepatocellular carcinoma (HCC).…”

“…Other treatment options include needle aspiration, 25 which is associated with a high recurrence rate, and sclerotherapy such as ethanol injection 26 . Since the first report of LF for liver cysts in 1991, 11,12 this procedure has been used as the standard method, although it has the risk of postoperative bile leakage 16 …”

“…However, excessive resection of the cyst wall can increase the risk of bile leakage from the cut edge of the liver cyst. [14][15][16] This is because the fine bile ducts are not visible through the cyst wall in the majority of cases, and it is difficult to decipher all of them during fenestration.…”

“…One of the surgical advantages that can be attributed to LF is the sufficient fenestration that prevents the recurrence of the cyst. However, excessive resection of the cyst wall can increase the risk of bile leakage from the cut edge of the liver cyst 14‐16 . This is because the fine bile ducts are not visible through the cyst wall in the majority of cases, and it is difficult to decipher all of them during fenestration.…”

The Use of Robotics in Surgery of Benign Liver Diseases: A Systematic Review

“…From the 1227 records retrieved, 12 studies were finally deemed eligible adding to a total of 115 patients. [14][15][16][17][18][19][20][21][22][23][24][25] The majority of studies were from centers in Asia (7/11), followed by Europe (3/11) and the United States (2/11). All included studies were published from 2013 onwards; however, the first robotic resections in the series were performed as early as 2007.…”