title: Minimally invasive sequential treatment of synchronous colorectal liver metastases by laparoscopic colectomy and robotic right hepatectomy.
abstract: OBJECTIVE
  The ideal timing for patients with colorectal cancer to undergo surgery for resectable synchronous liver metastases remains under debate. We describe a new sequential approach using laparoscopic/robotic surgery for the treatment of synchronous liver metastases.
  
  
  METHODS
  A 73-year-old man presented with sigmoid cancer and a single 8-cm right liver metastasis. A staged sequential minimally invasive approach was planned. A laparoscopic left colectomy was performed first, followed by a robotic right hepatectomy 10 days later.
  
  
  RESULTS
  The left colectomy lasted 120 min with a negligible blood loss (<10 mL). The right hepatectomy was completed robotically with an operating time of 330 min and intraoperative blood loss of 300 mL. The postoperative course was uneventful and the patient was discharged at postoperative day 8 of the liver resection. Three weeks later, the patient received adjuvant chemotherapy. At 26-months follow up, the patient was alive without recurrence.
  
  
  CONCLUSIONS
  This report suggests the technical feasibility and safety of a sequential totally minimally invasive approach for synchronous colorectal liver metastases. In selected patients, this approach can avoid the risk of a synchronous associate major liver/colonic resection using the advantages of minimally invasive surgery.
authors.affiliation: Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street Suite 435E, Chicago, IL 60612, USA. piercg@uic.edu
authors.forename: Pier Cristoforo
authors.initials: PC
authors.lastname: Giulianotti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Coratti
authors.forename: Pietro
authors.initials: P
authors.lastname: Addeo
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Bianco
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D012371:Robotics; D013997:Time Factors