Reduced-port robotic partial hepatectomy using a simultaneous colostomy-closure site via a glove-port: a case report

In patients with prior colorectal cancer, subsequent liver resection adds surgical trauma. We present a reduced-port robotic liver resection that reused the simultaneous colostomy closure site as a glove-port to minimize new incisions.

An 81-year-old woman had a 12-mm indeterminate lesion in liver segment 5 on surveillance computed tomography, 10 months after semi-emergency laparoscopic sigmoidectomy with a diverting colostomy for obstructing sigmoid colon cancer. The lesion was atypical for metastasis on positron emission tomography and gadoxetic acid-enhanced MRI, but could not be excluded as a metachronous metastasis, so simultaneous colostomy closure and robotic partial hepatectomy were performed. After bowel closure, a glove-port - a Small Alexis (R) wound retractor with a surgical glove - was placed at the stoma site and accommodated an 8-mm robotic trocar and a 12-mm assistant trocar through a single incision; three additional 8-mm robotic trocars and a Pringle tourniquet were inserted. The tumor was resected using a double bipolar technique and retrieved through the stoma site with the retractor left in place, without a retrieval bag. Histology revealed a benign focal nodular hyperplasia-like lesion; recovery was uneventful without surgical site infection.

Reusing a stoma site as a glove-port reduces skin incisions and avoids a separate extraction incision; the dual-ring wound retractor and a purse-string closure mitigate the infection risk associated with simultaneous stoma closure.

The glove-port technique using a stoma closure site is a feasible, minimally invasive option for selected patients with existing stomas, achieving an uneventful recovery without surgical site infection in this case.