Robot-assisted enucleation of gigantic liver hemangiomas: Case series of 3 patients. (2019)

• Record Type: Journal Article
• Authors: Giulianotti, Pier Cristoforo; Bustos, Roberto; Valle, Valentina; Aguiluz, Gabriela; Pavelko, Yevhen; Fernandes, Eduardo
• Is Part Of: International journal of surgery case reports. Volume 60(2019)
• Page Start: 244
• Page End: 248
• Publication Date: 2019
• Subjects: Hemangioma -- Liver -- Robotic -- Enucleation -- Resection -- Case series; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.06.033
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: The key aspect of this technique is to selectively control the arterial inflow. Mass enucleation represents the most challenging part of the procedure. ICG allows identifying the surgical plane between the mass and normal parenchyma. The robotic platform allows to replicate the enucleation performed in open surgery. Abstract: Introduction: Liver hemangiomas are benign liver lesions that require surgical excision when large and symptomatic. Often, these tumors are removed through large anatomical resections which sacrifice more liver parenchyma than needed. Tumor enucleation, which takes advantage of a digitoclasia-like technique along the plane between the tumor pseudo-capsule and liver parenchyma, poses challenges when performed laparoscopically. We propose a parenchymal sparing, minimally invasive, robotic-assisted technique to remove liver hemangiomas. Presentation of cases: Three male patients with symptomatic hemangiomas were treated in our center between 2015 and 2018. The lesions were located in segment II, III and segment IV-V respectively. Robotic-assisted hemangioma enucleation was accomplished successfully in all three patients. The procedures were performed with a parenchyma-sparing intent and a formal segmentectomy was not required. There were no conversions to open surgery. Discussion: The robotic platform provides a powerful tool in the enucleation of liver hemangiomas. The enhanced vision and the superior suturing ability allow to develop safely the plane between the tumor pseudo-capsule and the liver parenchyma, with outstanding selective control of all the vascular supply and drainage encountered during the dissection. Furthermore, precision of the hilar dissection allows selective lobar or sectorial arterial control which helps minimize intraoperative bleeding. Conclusion: In our experience, robot-assisted enucleation of liver hemangiomas offers low morbidity, fast recovery, excellent cosmetic results, and it could become a therapeutic option when the location of the hemangioma allows this approach.