Robotic Left Hepatectomy: a Case Report (First Reported Case of Robotic Hepatectomy in India)

Abstract

Robotic surgical platform is being increasingly used by liver surgeons for performing minimal invasive liver surgery, with results comparable to open surgery and added benefits of laparoscopic approach. The authors describe a case of robotic left hepatectomy done for recurrent pyogenic cholangitis. This is the first reported case of robotic hepatectomy done in India.Keywords Robotic . Liver . Resection . Recurrent pyogenic cholangitis Case ReportA 46-year-old male presented with history of recurrent fever with chills and abdominal pain since 2012. Endoscopic retrograde cholangiopancreatography (ERCP) done in September 2013 showed dilated left hepatic duct; papillotomy with balloon sweeping was done. Repeat ERCP and balloon sweeping was done for cholangitis in October 2014. ERCP for recurrent symptoms in March 2015 found dilated common bile duct, left hepatic duct, and left intrahepatic bile duct stricture; reaching a diagnosis of recurrent pyogenic cholangitis. Computed tomography (Fig. 1) showed cholangiolar abscesses in left lobe and intrahepatic bile duct dilation with pneumobilia. Magnetic resonance cholangiopancreatography showed mild dilation of common bile duct/left hepatic duct and left lateral segmental duct stricture with multiple pseudotumor in left lateral segment (Fig. 2). Liver function test showed mild elevation of alkaline phosphatase (179 IU/L) and gamma-glutamyl transferase (101 IU/L); carbohydrate antigen 19-9 was elevated at 160 U/ml. Total robotic left lobe liver resection was performed after treatment for cholangitis. Intraoperative and postoperative course was uneventful; no blood transfusion was required, and patient was discharged after 5 days. Pathology showed dilated, inflammed bile ducts and intrahepatic abscesses, with no evidence of malignancy.

Robotics in hepatobiliary surgery-initial experience, first reported case series from India

“…Total robotic left lobe liver resection was performed after treatment for cholangitis, as described in prior report [14].…”

“…The first resection was for recurrent pyogenic cholangitis in a 46 year old male, magnetic resonance cholangiopancreatography showed mild dilation of common bile duct/left hepatic duct and left lateral segmental duct stricture with multiple pseudotumor in left lateral segment. Total robotic left lobe liver resection was performed after treatment for cholangitis, as described in prior report [14] .…”

“…The authors report the first case series of robotic hepatobiliary cases from India, adding to the many series reporting on the safety, limited conversion rates, reasonable blood loss, and minimal postoperative morbidity, even for major hepatectomy [9], [10], [11], [12], [14], [15]; since the first reported use of robotic surgical system for liver surgery by Vibert E et al [16] in 2003 where they used it for pedicle dissection and initial hepatotomy.…”