Robotic Resection of Caudate Lobe Hepatocellular Carcinoma

Robotic liver resection is a valuable alternative to both open and laparoscopic techniques. We report a case of hepatocellular carcinoma (HCC) located in the caudate lobe, and the tumor was successfully resected with a robotic approach. When performed by experienced surgeons, robotic resection can be a technically sound and an oncological appropriate option for selected patients with complex hepatic tumors.

A 70-year-old man with a history of chronic hepatitis C infection, compensated cirrhosis, cholelithiasis, type 2 diabetes mellitus, and hypertension was referred to our transplant and hepatobiliary center following an incidental liver lesion finding during routine surveillance imaging. He was asymptomatic and his family history was notable for HCC. Physical examination and laboratory investigations were unremarkable. Abdominal ultrasound demonstrated a 4.6 cm hypoechoic mass in the caudate lobe, and cholelithiasis. Magnetic resonance imaging demonstrated a 4.2 × 4.0 cm lesion in segment one with arterial enhancement and washout. Triphasic contrast-enhanced computed tomography (CT) showed a 5 × 4.2 × 4 cm hypervascular mass, and esophagogastroduodenoscopy showed mild gastritis. A CT-guided needle biopsy from uninvolved right hepatic lobe revealed chronic hepatitis C and fibrosis. Metastatic workup was unremarkable. Robotic-assisted caudate lobectomy with cholecystectomy was performed with the da Vinci-5 robotic platform. The pathological report of the resected mass confirmed HCC with negative margins.

This case highlights the safety of robotic resection for HCC in the caudate lobe. With proper patient selection and more clinical experience, it is becoming a widely accepted option.