UC Surgeons Perform Breakthrough Robotic Liver Surgery

CINCINNATI—University of Cincinnati (UC) surgeons recently performed what is believed to be Ohio’s first robotic liver surgery.

Mark Thomas, MD, and Joseph Buell, MD, both transplant surgeons at UC, performed the operation on a 56-year-old man on Sept. 18 at University Hospital using the da Vinci robotic surgical system.

This patient had a bile-duct tumor in the left lobe of his liver that affected the organ’s function. Although the surgical team had to remove about 30 percent of his liver, the patient is doing well and is expected to fully recover.

Robotic surgery is a method of operating inside the abdomen using robotic “arms” and specialized instruments inserted through small incisions (about half an inch each) into the body. A surgeon controls these arms from behind a computer console several feet away from the patient.

“Robotic liver surgery is a sophisticated way to do an old surgery that benefits both the patient and the surgeons,” says Thomas, an assistant professor surgery at UC.

“The robotic arms essentially become an extension of the surgeon’s own hands and arms,” he adds, “but with the benefit of a 360-degree range of motion that’s not possible with traditional laparoscopic (minimally invasive) methods.”

The robotic approach, he says, provides better depth perception and fine-motion control inside the abdomen compared with traditional methods, which allows the surgeon to operate with greater precision and control suturing techniques.

“Robotic surgery extends the surgeon’s capabilities and makes the operation feel like open surgery without the need for a major incision into the abdomen,” adds Buell, an associate professor of surgery at UC. “That means the patient experiences less post-surgery pain and recovers faster.”

UC surgeons say the procedure is a safe, effective alternative to traditional “open” surgery for advanced liver disease and liver cancer—which requires up to a 30-inch incision.

The liver, one of the body’s largest organs, helps metabolize food and medicine that the blood absorbs from the intestines, produces bile to help digest fats, and stores energy-producing glycogen (sugar).

To perform the robotic liver procedure, carbon dioxide is pumped into the patient’s abdomen to increase the operative area and improve the surgeon’s view of the tumor. The surgeon then makes two to four small incisions to accommodate the robotic arms, a laparoscope (a tiny “telescope” equipped with a camera), and other specialized surgical instruments. The surgeon then severs and ties off the tumor’s blood supply, cuts out the tumor itself, places it inside a sealed bag, and removes it through one of the incisions.

“The liver is a self-healing organ,” explains Thomas, “so once the tumor is removed, the area typically heals within two to four weeks.”

Together, Thomas and Buell perform about 250 laparoscopic liver cases a year. According to Intuitive Surgical, maker of the da Vinci system, this is only the 42nd robotic laparoscopic liver resection surgery performed in the United States.

“The bottom line is that robotic surgery is an advantage for our patients—it results in less pain and faster recovery time,” says Buell. “We need to modify and grow this technology so we can provide the same advanced care to people in remote places.”

For more information on minimally invasive liver surgery at UC, visit www.lapliver.com.