Robotic anatomical right hepatectomy for metastatic clear cell carcinoma. Standardized approach using robotic platform

Introduction:Minimally invasive robotic technique is gaining popularity due to its technical advantages when compared with conventional laparoscopy.Minimally invasive major hepatic lobectomy, especially for the right side, however, remains a technically demanding procedure and requires extensive training to ensure safety and efficacy [1][2][3][4].Herein, we describe our standardized technical approach for anatomical right hepatectomy using robotic platform.Methods: An 81-year-old woman presented with a single 9 cm urothelial carcinoma liver metastasis to the right hepatic lobe.PET scan shows a large-sized hypermetabolic tumor with no evidence of other lesion or extrahepatic disease.After confirmation of tumor resectability, a right anatomical hepatic lobectomy is needed to gain oncological clearance.Hepatic inflow control was obtained by ligation of right hepatic artery and portal vein.Detailed technical operative steps are shown in the multimedia video attached to this paper.Results: Total operative time was 240 minutes, with an estimated blood loss of 75 mL.The patient had an uneventful postoperative recovery and she was discharged on postoperative day 4. Pathologic evaluation revealed a 9.0 cm metastatic urothelial carcinoma with negative resection margins margins.Currently, she is two years from the operation without any evidence of disease recurrence. Conclusion:This video highlights safe and effective practical steps in performing robotic anatomical right hepatic lobectomy.