First Report of Robotic-Assisted Liver Resection With Pre-Coagulation Technique by Microwave (With Video)

The high spatial cognition and freedom of forceps manipulation provided by robotic assistance enable three-dimensional liver resection. This is highly beneficial and innovative in laparoscopic hepatectomy. One of the remaining issues is bleeding control in cases of easily hemorrhagic cirrhotic liver. We reported a pre-coagulation technique by microwave. To our knowledge, this is the first report of robotic-assisted liver resection with a pre-coagulation technique by microwave.

The patient was a 71-year-old male with a history of alcoholic hepatitis and was diagnosed with a 2-cm HCC in segment 3. The preoperative indocyanine green retention test at 15 min (ICG-R15) was 18.9%; imaging studies showed findings suggestive of chronic hepatitis or cirrhosis. We decided to perform microwave pre-coagulation because of fears of difficulty in controlling bleeding. After taping the hepatoduodenal ligament, the location of the tumor was confirmed using ultrasound. The resection line with margin was marked on liver, and microwave pre-coagulation was performed, avoiding major Glisson branch and veins. The location of the pre-coagulated area and the tumor was determined by ultrasound. After pre-coagulation, the liver parenchyma was dissected under Pringle's maneuver by double bipolar technique. The operation time was 248 min; blood loss was 100 mL. The patient was discharged on the sixth postoperative day without intraoperative or postoperative complications.

Microwave pre-coagulation may be a useful approach to bleeding control in robotic hepatectomy. This technique would not necessarily be needed in all cases. However, it is important to have this knowledge to ensure safety in cases where hemostasis is expected to be difficult or when robotic hepatectomy is being introduced.