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Journal Surgery
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VISCERAL SURGERY VIDEOS
Robotic lateral resection of inferior vena cava extended to liver segment 7 for adrenocortical carcinoma recurrence (with video)
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Résection hépatique atypique du segment 7 élargie à la veine cave par voie robotique pour récidive d’un corticosurrénalome (avec vidéo)
Jacques-Emmanuel Saadouna, Farès Benmiloud b, Antoine Camerloa,*
a Département de chirurgie digestive, hôpital européen, 6, rue désirée Clary, 13003 Marseille, France
b Department of Head and Neck Surgery, hôpital européen, 6, rue désirée Clary, 13003 Marseille, France
Available online 5 October 2024
Radical surgery remains the cornerstone of adrenocortical carcinoma (ACC) management, even in localized recurrence [1]. However, resection can appear challenging due to invasion of adjacent structures, notably the inferior vena cava (IVC). The laparoscopic approach is poorly described in these patients [2]. Liver resection with vascular reconstruction could be facilitated with the advantages of the robotic platform. This video shows the resection of an adrenocortical carcinoma recurrence in liver segment 7 with vena cava control and lateral resection using the robotic platform. A 67-year-old woman underwent a laparo- scopic right adrenalectomy for ACC in 2021. Follow-up by PET scan showed a loco-regional recurrence one year later. CT scan and RMI showed lateral invasion of IVC with throm- bus in the right adrenal vein and involvement of segment 7 of the liver. After discussion in multidisciplinary tumor board, a surgical resection was decided. The robotic platform was docked by patient’s head. Surgery was conducted with an assistant located between the patient’s legs working through 2 laparoscopic ports [3]. The procedure started by an approach to the retro duodenal vena cava via a Kocher maneuver. Then, a complete mobi- lization of the right liver and the release of segment I was performed. A wedge resection of segment VII was carried out to pediculize the recurrence on the vena cava involvement.
* Corresponding author. E-mail address: antoinecamerlo@gmail.com (A. Camerlo).
The vena cava was clamped using two foley catheters. The lateral resection of the vena cava was done and the recon- struction was performed using continuous suturing with no need for graft interposition. The video shows the different steps necessary to perform this surgical procedure. Opera- tive time was 315 min, including IVC clamping for 18 min. Blood losses were 300 cc. The postoperative course was uneventful and the patient was discharged on postopera-
tive day 8. Pathological findings showed an adrenocortical carcinoma of 3 cm with tumoral thrombus in the adrenal vein, Weiss score 4. The margins of resection were free from tumor. This video will be useful for all surgeons perform- ing adrenal surgical procedures for benign and malignant tumors. It clearly shows that IVC control and lateral resec- tion can be perform using a laparoscopic robotic approach (Figs. 1-4).
Online supplement. Supplementary data
Supplementary data associated with this arti- cle can be found, in the online version, at https://doi.org/10.1016/j.jviscsurg.2024.07.007.
Disclosure of interest
The authors declare that they have no competing interest.
References
[1] Gaujoux S, Mihai R, Joint working group of ESES and ENSAT. European Society of Endocrine Surgeons (ESES) and European Network for the Study of Adrenal Tumours (ENSAT) recommendations for the surgical management of adrenocortical carcinoma. Br J Surg 2017;104(4):358-76, http://dx.doi.org/10.1002/bjs.10414.
[2] Cabrit N, Labiad C, Aussilhou B, Sartoris R, Sauvanet A, Dokmak S. Laparoscopic pancreatoduodenectomy with resection of the inferior vena cava and recon- struction with a peritoneal patch. Ann Surg Oncol 2022, http://dx.doi.org/10.1245/s10434-022-11550-z.
[3] Camerlo A, Magallon C, Vanbrugghe C, et al. Robotic hepatic parenchymal transection: a two-surgeon technique using ultrasonic dissection and irrigated bipolar coagulation. J Robot Surg 2021;15(4):539-46, http://dx.doi.org/10.1007/s11701-020-01138-8.