Advancing Robotic Liver Surgery: Robotic Approach to Massive Hepatic Echinococcosis in Situs Inversus Totalis

Introduction: Robotics provide a suitable platform to overcome technical challenges in minimally invasive surgery. In this video publication, we share the in-detail technique for a robotic liver resection for cystic echinococcosis in a patient with a situs inversus totalis. Materials and Methods: A 28-years-old patient presenting with abdominal pain and weight loss was diagnosed with cystic echinococcosis of the liver (WHO-ISGE CE2). Seropositivity for E. granulosis was confirmed. A perioperative medical treatment with albendazole was started, and the surgery was scheduled. 1 The resection was performed with an Intuitive Surgical DaVinci Xi system, using a tip-up fenestrated grasper, fenestrated bipolar forceps, and a SynchroSeal. A 12 mm laparoscopic assistance trocar was placed, and an extracorporeal Pringle for intermittent hilar clamping was installed. The trocar setup is visualized in the video. To gain operative space, some perihilar cysts were aspirated. The puncture site was hereby protected with a gauze compress drenched in 10% sodium chloride. Intraoperative ultrasound was repeatedly used to define the resection plane. The clamp-crush technique was applied for parenchymal dissection. Results: The operative time was 210 min, and the postoperative course was uneventful, with the patient being discharged on postoperative day 4. Albendazole was continued postoperatively. Conclusion: The use of robotic surgery for complex liver resections is still in development. 2 We here demonstrate the feasibility, safety, and in-detail technique of a robotic liver resection for a complex hydatid of the liver, tackling the challenges of a reduced operative space, infectivity of the cystic content, and a situs inversus totalis. Written informed consent was obtained from the patient for the recording and publication of the surgical video for academic and scientific purposes. The patient was informed about the nature and purpose of the video, the scope of its use, and their right to withdraw consent at any time without affecting their medical care. All efforts have been made to ensure the patient’s anonymity and confidentiality. Nora Nevermann, Anna Riddermann, Philipp Felgendreff, Linda Feldbrügge: none. Moritz Schmelzle: Merck Serono GmbH, Bayer AG, ERBE Elektromedizin GmbH, Amgen Inc., AstraZeneca, Avateramedical GmbH, Johnson&Johnson Medical GmbH, Takeda Pharmaceutical Limited, Olympus K.K., Medtronic GmbH, Intuitive Surgical Inc., Corzamedical, Baxter Int Inc. Runtime of video: 8 mins 24 secs.