Robotic Subtotal Cholecystectomy with Drainage of Liver Abscess and ICG Guided Debridement of Segment 4 of the Liver

Alan Saber, MD, FACS

Product Details
Product ID: ACS-6120
Year Produced: 2020
Length: 8 min.


Introduction: Recently the use of ?uorescence-guided hepatobiliary robotic surgery has signi?cantly increased and creating new interesting perspectives. We herein presenting a case of robotic subtotal cholecystectomy with drainage of liver abscess and ICG guided debridement of segments 4 the liver Presentation: A 67-year-old gentleman with diabetes, and renal failure who had kidney transplant. The patient had an acute cholecystitis that managed with IR percutaneous cholecystostomy tube placement at an outside institution. The cholecystostomy tube had been pulled and he developed a liver abscess. CT scan showed right pleural e!usion and a 5 x 3 x 2.5 cm hepatic abscess in segment 4 and multiple gallstones. Because of the persistent nature of the abscess, we decided to drain abscess surgically. Procedure: The robot was placed over the patient's right side and docked into place. Indocyanine green was given to aid in biliary anatomy identi?cation as well as identi?cation of abscess versus liver parenchyma. A large abscess was entered, and ICG guided debridement was achieved. The di"culty in identifying the cystic duct and artery and the intrahepatic location of the gall bladder mandated a top-down approach subtotal cholecystectomy. Omental ?ap was created to pack the resultant hepatic cavity. The patient tolerated the procedure well and went home on POD# 3. Conclusion: Fluorescence-guided robotic drainage and debridement of liver abscess is safe and feasible. The use of robot with its high degree of freedom of movement allows precise maneuvers in a narrow surgical ?eld and overcomes the challenges in acute care abdominal surgery.