Background: We present a 50-year-old male found to have moderately differentiated adenocarcinoma of the colon on screening colonoscopy. He underwent a left colectomy with final pathology showing pT4aN0 (0/23 LN). Post-operative MRI and PET scan were positive for two liver lesions, one near segment 4B/5 and another in segment 2. The was no other evidence of metastatic disease. We planned for a segment 4B/5 liver resection, cholecystectomy, and left sectionectomy versus segment 2 resection. We opted for a minimally invasive robotic approach.
Methods:Intraoperative ultrasound was used to scan the liver for additional lesions. The segment 4B/5 and 2 lesions were grossly visualized, but four additional lesions were identified in the right liver. Given the disease burden in the right liver with risk for recurrence, we decided to perform an isolated resection of the segment 2 liver lesion.
Results:The partial sectionectomy was performed with the DaVinci Xi Robot. Using fine dissection with a Harmonic scalpel there was minimal blood loss. The specimen was extracted through a Pfannenstiel incision. The patient had an uneventful postoperative course and was discharged on post-operative day 1. Pathology confirmed two lesions with moderately differentiated adenocarcinoma.
Conclusion:Robotic hepatic resection is safe and effective for metastatic colon adenocarcinoma with minimal blood loss or complications and a quick post-operative recovery. The use of Harmonic scalpel for parenchymal dissection achieves excellent hemostasis while allowing for identification and individual attention to the vessels and ducts.