Robotic Resection of Postero-Superior Liver Segments (7,8) (with Video).

Background: Surgical resection is the standard treatment for colorectal liver metastases. Parenchyma-sparing technique should always be attemptedto prevent postoperative liver failure and increase the opportunity to perform repeated resections in cases of recurrent malignancy. Postero-superior liverresection is defined as the anatomical removal of liver segments 7 and 8, however, minimally invasive resection of postero-superior liver segments isconsidered a difficult and complex operation and thus is rarely reported.

Methods: We present the video of a robotic postero-superior liver resection in a 54-year-old male patient with a synchronous, single, and large colorectal metastasis in the postero-superior liver sector. The Da Vinci Xi system was used. The right liver was mobilized with exposure of the inferior vena cava (IVC), following by intraoperative ultrasound, used to locate the tumor and establish its relationship to the right hepatic vein and portal pedicles fromsegments 7 and 8. A thick hepatic vein draining directly to the IVC was controlled with hem-o-lock and the right hepatic vein was divided using anendoscopic stapler. The surgical specimen was removed through a supra-pubic incision.

Results: Operative time was 205 minutes, and the estimated blood loss was 310 mL. The patient's recovery was uneventful with no need for admission tothe intensive care unit or for blood transfusion. Pathology confirmed colorectal metastasis with free surgical margins.

Conclusions: Robotic resection of postero-superior liver segments is feasible and safe and may have some advantages over laparoscopic and openapproaches. This video may help gastrointestinal surgeons perform this complex procedure.