Robotic Hepatic Artery Infusion Pump Placement after Recurrent Colorectal Liver Metastasis following Open Left...

Minimally invasive surgical techniques for placement of hepatic artery infusion pump are gaining popularity over the traditional open method, even in patients who had undergone prior open abdominal and open liver operation.^1-4 In this video, we described our technique of robotic hepatic artery infusion pump placement after prior open left hemihepatectomy and colorectal resection for recurrent multifocal liver metastasis from rectal cancer.

This video demonstrates the technique in a 62-year-old man with a history of recurrent multiple liver metastases from rectal cancer following adjuvant chemotherapy (FOLFOX for 6 months) and curative-intent resection of rectum and liver. Initial computed tomography/magnetic resonance imaging (CT/MRI) scans showed multiple recurrence in the remnant liver, deemed to be unresectable. Positron emission tomography (PET) scan showed multiple PET-avid lesions consistent with metastatic recurrence and absence of extra-hepatic disease. A robotic approach to hepatic artery infusion pump placement was then undertaken. A schematic image of port placement in relation to the location of the hepatic artery infusion pump is included in the video. Hepatic arterial anatomy was very carefully exposed using bipolar Maryland forceps to avoid thermal injury to the vessel wall. For the purpose of clarity, hepatic artery tributary has been labeled.

Total operative time was 150 min, with an estimated blood loss of 75 mL. The patient was discharged on postoperative day 3 without any complications. Postoperatively, a Tc-99m nuclear medicine scan was performed showing uniform hepatic perfusion without extra-hepatic perfusion.

This case highlights the safety and feasibility of utilizing a minimally invasive robotic approach in hepatic artery infusion pump placement after an open left hemihepatectomy.