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First ALPPS procedure using a total robotic approach.

E Vicente¹, Y Quijano¹, B Ielpo¹

¹Madrid Norte Sanchinarro San Pablo University Hospital, General Surgery Department, Calle Oña 10, 28050, Madrid, Spain.

Surgical Oncology

|February 10, 2016

Summary

This study demonstrates the first totally robotic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure. The robotic approach proved safe and feasible for liver surgery, offering potential advantages over traditional methods.

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Area of Science:

Minimally Invasive Surgery
Hepatobiliary Surgery
Surgical Robotics

Background:

The Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) procedure is increasingly recognized, yet its indications and technical nuances remain subjects of ongoing discussion.
Literature review reveals a scarcity of totally laparoscopic ALPPS cases and no reported instances of robotic-assisted approaches.

Observation:

A 58-year-old male patient with sigmoid adenocarcinoma and extensive liver metastases underwent neoadjuvant chemotherapy.
Preoperative imaging indicated a Future Liver Remnant to Total Liver Volume (FLR/TLV) ratio of 28%.
The procedure was performed using the DaVinci Si robotic system.

Findings:

The first stage involved tumor resection and parenchymal transection with portal vein ligation.

Keywords:

ALPPS Hepatectomy Robotic surgery

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The second stage, completed robotically on postoperative day 13, showed an increased FLR/TLV of 40% with minimal adhesions.

Surgical resection of the right hepatic artery and suprahepatic vein was performed, with the specimen retrieved through a Pfannenstiel incision. Postoperative pathology confirmed disease-free margins.

Implications:

Totally robotic ALPPS can be a safe and feasible surgical option.
This technique may be particularly beneficial in experienced centers with advanced robotic surgical expertise.
Robotic assistance may facilitate staged liver resections, potentially improving outcomes for complex hepatobiliary cases.