Liver Resection with Da Vinci Robot Arm (1)

Mr. Li was diagnosed with liver metastasis of colon cancer two years ago. He recovered well after surgical resection of colon and liver tumors and chemotherapy. However, a recent positron scan found metastatic tumors in the caudate lobe of the liver. After discussion between oncology department and liver surgeon, surgical resection is suggested, which can control the disease well. But Mr. Li is a little hesitant because he is worried that the surgical wound is too big. Fortunately, after the assessment of the surgeon, it was suggested that the caudate Ye Quan resection of the liver should be performed by the mechanical arm, which was successfully completed through minimally invasive wound. After the operation, the patient resumed eating the next day and was discharged smoothly on the fifth day. The medical team was glad that Mr Li Can was reborn with the help of advanced medical technology.

Traditional tumor resection often causes patients to flinch because the wound is too big. The robotic arm surgery system was originally designed by the US Department of Defense and the US National Aeronautics and Space Administration (NASA) to study remote surgery. With the progress of science and technology and the accumulation of surgeon's experience, it has been successfully applied to urology, obstetrics and gynecology, cardiac surgery and digestive surgery. Due to the high dexterity of the manipulator, the function of three-dimensional image and image fusion. It is especially suitable for tissue anatomy, lymph gland clearance and reconstruction suture in narrow space. Such as resection and reconstruction of prostate cancer, resection and suture of uterine fibroids and repair of heart valves.

In addition, the application of digestive surgery is increasing, such as early gastric cancer resection and thyroidectomy. As for the manipulator surgery of hepatobiliary and pancreatic diseases, it developed late because of its high complexity.

Liver resection has always been a challenging operation because of its rich blood vessels and complex anatomical structure. The earliest laparoscopic hepatectomy was proposed by M Gagner in 1992. Because of the high technical threshold and long time consuming, it is not accepted by most surgeons as laparoscopic cholecystectomy. However, in recent years, with the accumulation of experience and the progress of instruments and equipment, laparoscopic hepatectomy has been gradually accepted by the surgical medical community, but it is limited to a few medical centers with complicated operations and high minimally invasive degree. The tumor is preferably located around the liver, and the size is preferably less than 5 cm. If the tumor is located deep in the liver or near large blood vessels, the traditional laparoscopic hepatectomy will also be limited by the angle of the instrument, and sometimes it can not be carried out smoothly and safely. The principle of minimally invasive hepatectomy is the same as that of traditional open surgery, which requires the resection distance from the tumor boundary to the resection surface to be at least 1 cm.

The general surgery team in our hospital has been carrying out laparoscopic hepatectomy for many years. At present, we have accumulated about 300 cases of traditional laparoscopic hepatectomy and Da Vinci robotic arm hepatectomy, which is an experienced team in this field in China. The largest tumor is near 1 1 cm, and its location is no longer limited by traditional indications. However, the tumor located at the top of the liver near the diaphragm and caudate lobe is difficult to be performed with traditional laparoscopic instruments because of its special position.