Robotic Liver Resection for a Precancerous Liver Tumor in a Young Man. Technique of Preserving Uninvolved Liver Segments
During the 2023 Society of Gastrointestinal and Endoscopic Surgeons (SAGES) meeting in Montreal Canada, Dr. Sucandy and his team presented a case of a robotic liver resection in man with a large precancerous liver tumor called hepatic adenoma. The video was selected as the best instructional video for the liver surgery session. SAGES is a very prestigious international surgical conference, attended by approximately 10.000 surgeons from around the world bringing their expertise to share with other colleagues.
A 40-year-old man presented to Dr Sucandy’s office after a referral by his primary care doctor for a new finding of an 8 cm liver tumor. The workup was completed with a CT scan and MRI scan which were consistent with a hepatic adenoma, a type of precancerous liver tumor.
The standard management for a hepatic adenoma is a liver resection when the adenoma has reached 4 cm or beyond. When the adenoma reaches this size, the risk of malignant transformation increases exponentially.
In this patient, the location of the adenoma was in the very far back of the liver requiring a full rotation of the liver. The operation was considered technically difficult due to its deep location.
Preservation of noninvolved part of the liver is important in an otherwise young patient. This is called parenchymal sparing liver surgery, which is always the goal in modern liver surgery.
The operation was planned as right posterior sectionectomy which means removal of only liver segment 6 and 7. This specific operation is technically more complicated than removal of the entire right side of the liver. In the discipline of robotic liver surgery, right posterior sectionectomy requires complete mastery of major liver resection.
At the time of this operation, Dr. Sucandy and his team have completed 450 robotic liver resections with 50% of them being major liver resections. This extensive experience has given them adequate skills to perform this complex operation safely and effectively.
The operation began with positioning of the patient. Once the robotic system was docked, the operation then began. The liver was exposed and the tumor location was marked in relation of vital blood vessels after a proper mobilization.
The liver resection was performed in a bloodless fashion by Dr Sucandy and his team. The operative duration was 7 hours. The dissection of various vessels and bile ducts within the liver were done very precisely between locking clips.
The use of robotic system was very helpful in this type of complex liver resection when performed by an experienced robotic liver surgeon. The precision and detailed exposure of various structures are very important keys in liver surgery to avoid complications such as delayed bleeding, bile leak, or abscess.
The patient recovered well without any complications. The pain was quite minimal. The patient was able to walk the hospital hallways the following morning with ease. The final pathology report confirmed the tumor to be a hepatic adenoma.
This technical report was important in facilitating learning and transfer of knowledge to younger trainees in liver surgery. The minimally invasive liver surgery requires a long learning curve, especially for complex resections such as right posterior sectionectomy, however this modern technique can bring tremendous benefits for many patients with liver tumor.
Obviously, surgeon selection is important for success in any liver operations. Dr Sucandy and his team are the pioneers of robotic liver surgery in the US and world. Their experience in robotic liver surgery is unparalleled by other teams.