Robotic-assisted cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC)

Emmanuel Gabriel, Enrique Elli, Sanjay Bagaria, Nabil Wasif, Travis Grotz, John Stauffer, Pashtoon M. Kasi, Horacio Asbun

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is an appropriate treatment for select patients with peritoneal carcinomatosis. While most commonly performed through an open incision, the laparoscopic approach has been reported and offers short-term benefits. A robotic-assisted approach for carcinomatosis of gastrointestinal origin, however, has not yet been described. We report our approach to robotic-assisted CRS-HIPEC for a patient with a perforated appendiceal mucocele. Our dynamic video highlights the advantages of this approach. Our patient was a 57-year-old woman with minimal residual disseminated peritoneal adenomucinosis (DPAM), having a peritoneal carcinomatosis index (PCI) score of 1. She had a previous surgical history of a Roux-en-Y gastric bypass. A robotic-assisted approach was utilized using the Intuitive daVinci Xi robotic surgical system through 4 ports. No laparoscopic assistant port was required. The operative time was 426 min, and the estimated blood loss was 50 cc. The greater omentum, falciform ligament, bilateral ovaries, and two small areas of tumor implant were resected. The post-operative length of stay was 4 days, and the patient had regained bowel function by post-operative day 2. Our video demonstrates the feasibility of a robotic-assisted CRS-HIPEC in a patient with minimal, residual DPAM. Similar to a laparoscopic approach, the short-term outcomes are improved as compared to an open approach. An MIS approach to CRS-HIPEC, now with the first-reported robotic-assisted approach, is a viable option for select patients with peritoneal tumors.