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Awake robotic liver surgery: A case report.

Antonella Delvecchio1, Gaetano Pavone2, Maria Conticchio1

  • 1Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" Regional General Hospital, Bari 70021, Italy.

World Journal of Gastrointestinal Surgery
|January 15, 2024
PubMed
Summary
This summary is machine-generated.

Robotic liver resection using spinal-epidural anesthesia with conscious sedation offers a safe alternative for fragile patients, avoiding general anesthesia and its respiratory risks.

Keywords:
Awake surgeryCase reportConscious sedationFrail patientLiver resectionLocoregional anesthesiaRobotic surgery

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Anesthesiology

Background:

  • Minimally invasive liver resection is standard for liver tumors, but general anesthesia poses risks for fragile patients.
  • Epidural anesthesia can reduce respiratory complications, particularly in elderly patients with lung disease.
  • Curative surgical treatment is sometimes foregone due to anesthesia-related risks.

Observation:

  • A 77-year-old male with hepatitis C, hypertension, diabetes, and COPD underwent robotic liver resection for hepatocellular carcinoma.
  • The patient had a 9.2% predicted risk of pneumonia per the National Surgical Quality Improvement Program.
  • Combined spinal-epidural anesthesia with conscious sedation was employed to avoid general anesthesia.

Findings:

  • The robotic liver resection proceeded without modification to the standard technique.
  • Hemodynamics remained stable throughout the procedure, with minimal blood loss.
  • The patient experienced an uneventful postoperative recovery.

Implications:

  • Robotic liver resection under regional anesthesia with conscious sedation is a viable option for selected high-risk patients.
  • This approach may expand surgical candidacy for curative liver cancer treatment.
  • Specialized centers can safely implement this anesthetic and surgical strategy.