Surgical robot can help safely remove the caudate lobe

Resection of tumors within the caudate lobe (a deep, hard-to-reach a part of the liver) is acknowledged as one of the technically difficult procedures in hepatic surgical procedure as a result of its distinctive anatomical place and complicated vascular relationships.

Researchers at Boston College Chobanian & Avedisian Faculty of Medication now present that it’s doable to take away the caudate lobe safely utilizing a surgical robotic, even in an older affected person, and nonetheless take away the most cancers utterly. The medical case they describe within the journal Annals of Surgical Oncology, combines two “steerage” instruments (1) a dangling/traction approach utilizing the Arantius ligament and (2) Indocyanine inexperienced (ICG) “destructive staining” to obviously mark the caudate lobe boundaries and information a margin-focused most cancers operation in a really tough space.

“The caudate lobe is among the most technically demanding areas of the liver-it’s deep and surrounded by crucial vessels,” mentioned corresponding creator Eduardo Vega, MD, assistant professor of surgical procedure. “Robotic surgical procedure may help us take away choose tumors via smaller incisions, with much less ache and blood loss and faster restoration, whereas nonetheless aiming for treatment.”

The researchers describe step-by-step a surgical approach they used to deal with a 79-year-old affected person who had rectal most cancers and liver metastasis within the caudate area. They started through the use of an intraoperative ultrasound to seek out the tumor and map close by vital blood vessels. Utilizing a surgical robotic, they then used a dangling maneuver with the Arantius ligament to open a secure working house close to main vessels. Subsequent, they briefly blocked the small portal department feeding the caudate lobe and injected a small dose of ICG dye (2.5 mg). Below the close to‑infrared digital camera, the rest of the liver lit up whereas the caudate lobe stayed darkish, which allowed the surgeons to see the borders clearly and defending crucial buildings whereas eradicating the caudate lobe.

After the liver process, the first tumor (superior rectal most cancers) was resected robotically. This enabled definitive most cancers resection completely by way of a minimally invasive robotic method, and the affected person accomplished subsequent remedy with out problems.

“Our purpose is to make advanced liver tumor surgical procedure safer and fewer invasive, so extra sufferers can get well sooner and nonetheless obtain a healing operation. By combining robotic precision with ultrasound and fluorescence steerage, we hope to develop entry to high-quality most cancers surgery-even for tumors within the hardest-to-reach areas of the liver,” provides Vega, who is also a hepato-bilio-pancreatic surgeon at Boston Medical Middle.