Robot-assisted laparoscopic hepatectomy for hepatocellular carcinoma with Fontan-associated liver disease: a world-first case report
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Updated: Jun 13, 2025
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Takuma Ishikawa1, Shinji Itoh2, Takeo Toshima1
1Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1 Maidashi, Higashi-Ku, Fukuoka-Shi, Fukuoka, 812-0054, Japan.
Background:
Fontan-associated liver disease (FALD) encompasses hepatic complications following the Fontan procedure, ranging from fibrosis to hepatocellular carcinoma (HCC). Despite advancements in surgical techniques and perioperative care, robot-assisted laparoscopic hepatectomy (RALH) for HCC in patients with FALD has not been previously reported owing to concerns about the Fontan circulation.
Case Presentation:
We present the first case of RALH for recurrent HCC in a 45-year-old man after the Fontan procedure. The preoperative evaluation confirmed good cardiac function. The procedure involved meticulous monitoring and management of central venous pressure and was successfully completed with minimal blood loss. Postoperative recovery was uneventful. With thorough preoperative cardiac assessment and close collaboration between cardiologists and anesthesiologists, RALH can be safely performed in selected patients with FALD.
Conclusions:
Even if a patient has a history of FALD, RALH can be safely performed in selected patients under appropriate conditions.
