Robotic surgical platform is being increasingly used by liver surgeons for performing minimal invasive liver surgery, with results comparable to open surgery and added benefits of laparoscopic approach. The authors describe a case of robotic left hepatectomy done for recurrent pyogenic cholangitis. This is the first reported case of robotic hepatectomy done in India.Keywords Robotic . Liver . Resection . Recurrent pyogenic cholangitis
Case ReportA 46-year-old male presented with history of recurrent fever with chills and abdominal pain since 2012. Endoscopic retrograde cholangiopancreatography (ERCP) done in September 2013 showed dilated left hepatic duct; papillotomy with balloon sweeping was done. Repeat ERCP and balloon sweeping was done for cholangitis in October 2014. ERCP for recurrent symptoms in March 2015 found dilated common bile duct, left hepatic duct, and left intrahepatic bile duct stricture; reaching a diagnosis of recurrent pyogenic cholangitis. Computed tomography (Fig. 1) showed cholangiolar abscesses in left lobe and intrahepatic bile duct dilation with pneumobilia. Magnetic resonance cholangiopancreatography showed mild dilation of common bile duct/left hepatic duct and left lateral segmental duct stricture with multiple pseudotumor in left lateral segment (Fig. 2). Liver function test showed mild elevation of alkaline phosphatase (179 IU/L) and gamma-glutamyl transferase (101 IU/L); carbohydrate antigen 19-9 was elevated at 160 U/ml. Total robotic left lobe liver resection was performed after treatment for cholangitis. Intraoperative and postoperative course was uneventful; no blood transfusion was required, and patient was discharged after 5 days. Pathology showed dilated, inflammed bile ducts and intrahepatic abscesses, with no evidence of malignancy.