PMC5107666_01
(A) Liver CT axial view: A 2 cm hypervascular tumor (arrow) was located at the S7 liver dome. (B) Liver CT coronary view: The tumor was located at the dorsal aspect of the liver dome. (C) A 1 cm renal tumor was located at the upper pole of the right kidney; we suspected that the tumor was renal-cell carcinoma.
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He had a regular annual physical examination in our hospital, and incidentally, a 3 cm hypervascular tumor was observed at the S7 liver dome in an abdominal computed tomography scan; hepatocellular carcinoma (HCC) with liver cirrhosis was suspected (Fig. 1A, B). He had another 1 cm exophytic tumor lesion that appeared to be renal-cell carcinoma (RCC) at the upper pole of the right kidney (Fig. 1C).
Trocar position: The camera port was placed at the midaxillary line of the midpoint between the 12th rib and iliac crest. The second robotic arm port was placed at the triangular area of the lumbodorsal fascia and 12th rib; the first and third robotic arm ports were placed at the right subcostal margin with an 8 cm distance between each port. An accessory port was placed at the right lower quadrant of the abdominal wall that depended on the tumor location.
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Three robotic and one assistant working ports were inserted under endoscopic monitoring and finger guidance (Fig. 2).
The peritoneum was thin, and the liver could be clearly identified posteriorly; this position could reduce the risk of transverse or ascending colon injury.
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With the same docked Da Vinci system, the peritoneal layer was identified and incised after confirming with direct vision that no visceral organ was behind it (Fig. 3).