Robotic Hepatic Artery Infusion (HAI) Port Placement for Liver-Directed Intra-Arterial Chemotherapy: Initial...

Colorectal liver metastases (CRLM) and intrahepatic cholangiocarcinoma (iCCA) often present challenges due to extensive liver involvement that limits surgical resection. Hepatic artery infusion (HAI) therapy enables high local drug concentrations by exploiting the hepatic artery's dominant role in tumor perfusion. Historically performed via open surgery, HAI port placement has evolved with the advent of robotic-assisted techniques, offering reduced morbidity and enhanced precision. This study reports the initial experience of robotic HAI port placement for liver-directed chemotherapy at a tertiary care Indian cancer center-the first such report from India. Eleven patients with CRLM underwent robotic-assisted HAI port placement between July 2024 and April 2025. Preoperative multidetector CT angiography assessed hepatic arterial anatomy. The procedure utilized the DaVinci X robotic system, with port placement into the gastroduodenal artery and mandatory cholecystectomy. Key perioperative data-including operative time, blood loss, and complications-were recorded. Postoperative outcomes were analyzed, excluding combined resection cases where relevant. The cohort's mean age was 58.4 years; 81.8% were male. Aberrant arterial anatomy was identified in 27.3% of patients. No conversions to open surgery occurred. Mean operative time was 187 min (124 min for HAI-alone cases); mean blood loss was 134 ml (83 ml for HAI-alone cases). Three patients (27.3%) underwent simultaneous colorectal resection. Median hospital stay was 4 days (2 days for HAI-alone cases). Only one minor postoperative complication occurred, and no major complications were reported. Robotic-assisted HAI port placement is a safe, feasible, and effective minimally invasive option for regional chemotherapy in CRLM. Our initial experience demonstrated excellent technical success, minimal morbidity, and rapid recovery, even in patients with variant hepatic arterial anatomy. These promising results suggest robotic placement may surpass traditional methods, warranting further validation in larger studies with extended follow-up.