title: Robotic liver resection as a bridge to liver transplantation.
abstract: BACKGROUND
  The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentation. Robotic surgery for hepatic resection has not yet been extensively reported. The aim of this article is to report the first known case of liver resection with the use of a robot in France.
  
  
  METHODS
  A 61-year-old male with hepatitis C liver cirrhosis and hepatocellular carcinoma was referred for surgical treatment. Preoperative clinical evaluation and laboratory data disclosed a Child-Pugh class A5 patient. Magnetic resonance imaging showed a 3.4-cm tumor in segment III. Liver size was normal, and there were not signs of portal hypertension. Five trocars were used.
  
  
  RESULTS
  Liver transection was achieved with Harmonic scalpel and bipolar forceps without pedicle clamping. Hemostasis of raw surface areas was accomplished with interrupted stitches. Operative time was 180 minutes. Blood loss was minimal, and the patient did not receive transfusion. The recovery was uneventful, and the patient was discharged on the fifth postoperative day without ascites formation.
  
  
  CONCLUSIONS
  The robotic approach may enable liver resection in patients with cirrhosis. The da Vinci robotic system allowed for technical refinements of laparoscopic liver resection due to 3-dimensional visualization of the operative field and instruments with wrist-type end-effectors.
authors: Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hopitaux Universitaires de Strasbourg, Strasbourg, France. f-panaro@chu-montpellier.fr
authors: Fabrizio
authors: F
authors: Panaro
authors: Tullio
authors: T
authors: Piardi
authors: Murat
authors: M
authors: Cag
authors: Jacques
authors: J
authors: Cinqualbre
authors: Philippe
authors: P
authors: Wolf
authors: Maxime
authors: M
authors: Audet
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000379:methods*; D014057:Tomography, X-Ray Computed