Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2954
Peer-review started: September 22, 2023
First decision: October 17, 2023
Revised: October 30, 2023
Accepted: December 6, 2023
Article in press: December 6, 2023
Published online: December 27, 2023
Processing time: 96 Days and 8.1 Hours
In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease.
A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal–epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful.
Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.
Core Tip: Liver resection represents a gold standard for the treatment of liver malignancies. Minimally invasive approach guarantees less invasiveness and faster postoperative recovery. Frail and older patients undergoing liver resection under general anesthesia have a high risk of respiratory and cardiac complications. Locoregional anesthesia preserves better intestinal, cardiac and pulmonary function compared to general anesthesia. The combination of robotic surgery and locoregional anesthesia guarantees minimal surgical and anesthetic invasiveness and could be considered a safe approach in selected patients and specialized centers.