Robot Assisted Laparoscopic Left Lateral Non-Segmentectomy Combined with Planar Coagulation

Subhashini M. Ayloo, MD, MPH, FACS; Jacob Schwartzman, MD

Product Details
Product ID: ACS-5662
Year Produced: 2018
Length: 9 min.


Objective: To demonstrate the safety and feasibility of robot-assisted left lateral non-segmentectomy for a hepatic cyst using planar coagulation with microwave ablation in an octogenarian. Materials And Methods: An 84 year old woman with a known hepatic cyst since 2008, followed with diagnostic imaging, is referred for a change in the cyst characteristics. Although imaging showed a decrease in cyst size, the characteristics of the cyst changed from simple to complex with heterogeneity within the cyst. This video showcases the technical details of a minimal invasive approach to left lateral non-segmentectomy using planar coagulation. A diagnostic laparoscopy is performed, showing significant adhesions. A stay suture is placed in the inferior portion of segment 3, to retract the left lateral lobe laterally. Intraparenchymal dissection is performed using a combination of sequential planar coagulation with a microwave ablation and harmonic shears. Dissection of the hepatic parenchyma continues until the left hepatic vein is reached. This is transected using an Endo-GIA stapler. Hemostasis is achieved, and the specimen is extracted via a Pfannensteil incision. Conclusions: Robot-assisted left lateral non-segmentectomy with planar coagulation with microwave ablation is safe and feasible an octogenarian. It decrease the operative time and blood loss even when the dissection is performed in non-segmental plane.