Totally robotic caudate lobe liver resection: Bridge over troubled water.

BACKGROUND: Minimally invasive hepatectomy has well-known advantages over the traditional open approach. Inherent limitations of laparoscopy make major hepatectomies and the resection of upper and posterior segments a great technical challenge. The robotic approach overcomes most of these limitations, and this technology is most useful in the resection of the deeply located caudate lobe. METHODS: We describe the robotic caudate lobe resection technical aspects, using the first robotic resection of the caudate lobe to treat a biphenotypic hepatocholangiocarcinoma to illustrate the procedure. We also performed a literature review on the current status of the robotic approach to segment (Sg) 1. RESULTS: Technical approach to the robotic caudate lobe resection is described in a patient with uneventful post-operative recovery. Literature review demonstrated only four previous authors reporting the use of this technique. CONCLUSION: We present a step-by-step approach to the hepatic Sg 1 resection by robotic approach.

Long-term survival after surgical treatment followed by adjuvant systemic therapy for primary duodenal melanoma.

Primary mucosal malignant melanomas of the gastrointestinal tract are rare tumors associated to poor prognosis. Primary duodenal involvement by pigmented lesions is even more uncommon, and only a few reports exist in the literature. We report the case of a patient with large primary duodenal melanoma that presented with upper intestinal obstruction and bleeding that was submitted to urgent pancreaticoduodenectomy followed by adjuvant systemic therapy with an oral alkylating agent (temozolomide) plus intravenous cisplatin. The patient presents no signs of recurrence 3 years after the surgery. We consider that radical surgical resection followed by systemic therapy is a safe and effective treatment strategy option for primary mucosal gastrointestinal melanomas.