Fully Robotic ALPPS and Simultaneous Left Colectomy for Synchronous Colorectal Liver Metastases

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a recent surgical advancement for increasing the rate of successful liver resection. This technique is particularly important for patients with advanced tumor burden in whom future liver remnant volume is estimated to be too small to meet hepatic metabolic demands. With increasing acceptance of laparoscopic liver surgery and the related experience, even complex liver resection techniques such as ALPPS have been performed laparoscopically to improve patient outcomes. However, conventional laparoscopy has certain technical limitations that can result in a lack of dexterity. By overcoming these limitations, robot-assisted laparoscopy could become the preferred procedure for complex liver resection. In this study, we describe the technique of fully robotic ALPPS with simultaneous left colectomy in a patient with stage IV colorectal cancer. We emphasize on the performance of the robotic platform during certain difficult steps of the procedure.