Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Awake robotic liver surgery: A case report
Antonella Delvecchio, Gaetano Pavone, Maria Conticchio, Claudia Piacente, Miriam Varvara, Valentina Ferraro, Matteo Stasi, Annachiara Casella, Rosalinda Filippo, Michele Tedeschi, Carmine Pullano, Riccardo Inchingolo, Vito Delmonte, Riccardo Memeo
Antonella Delvecchio, Maria Conticchio, Valentina Ferraro, Matteo Stasi, Annachiara Casella, Rosalinda Filippo, Michele Tedeschi, Riccardo Memeo, Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
Gaetano Pavone, Claudia Piacente, Miriam Varvara, Vito Delmonte, Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
Carmine Pullano, Villa Pia Hospital, Rome 00151, Italy
Riccardo Inchingolo, Unit of Interventional Radiology, “F. Miulli” Regional General Hospital, Bari 70021, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Riccardo Inchingolo, MD, Director, Doctor, Unit of Interventional Radiology, “F. Miulli” Regional General Hospital, Strada per Santeramo, Bari 70021, Italy. riccardoin@hotmail.it
Received: September 22, 2023
Peer-review started: September 22, 2023
First decision: October 17, 2023
Revised: October 30, 2023
Accepted: December 6, 2023
Article in press: December 6, 2023
Published online: December 27, 2023
BACKGROUND
In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease.
CASE SUMMARY
A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal–epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful.
CONCLUSION
Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.
Core Tip: Liver resection represents a gold standard for the treatment of liver malignancies. Minimally invasive approach guarantees less invasiveness and faster postoperative recovery. Frail and older patients undergoing liver resection under general anesthesia have a high risk of respiratory and cardiac complications. Locoregional anesthesia preserves better intestinal, cardiac and pulmonary function compared to general anesthesia. The combination of robotic surgery and locoregional anesthesia guarantees minimal surgical and anesthetic invasiveness and could be considered a safe approach in selected patients and specialized centers.
