Background : The dissemination of robotic liver surgery is slow-paced and always runs the uphill task of of demonstrating advantages over open and laparoscopic approaches. Although laparoscopy is much more widely practised for a left lateral sectionectomy, robotic platform provides an added advantage of utilising the assistant laparoscopy port for liver transection.

Methods : We present a case of a 32 year old gentleman previously operated for a robotic low anterior resection for carcinoma rectum post perioperative chemoradiotherapy who presented with a metachronous segment II liver lesion.

Results : Patient was discussed in multidisciplinary team discussion and planned for an upfront robotic left lateral sectionectomy using the DaVinci Xi platform. Indocyanine green (0.5mg/kg) was administered 5 days prior to surgery. A standard four 8 mm robotic port placement was used with two 12 mm laparoscopic assistant ports. Liver parenchymal transection was done with a combination of robotic monopolar scissors, bipolar Maryland forceps and laparoscopic CUSA under ICG guidance. The procedure was completed in 180 minutes with 150 ml blood loss. The patient had an uneventful post-operative recovery. The final histopathology revealed a metastatic adenocarcinoma with resection margins free (R0). The patient was planned for adjuvant chemotherapy with adjuvant hepatic artery infusion chemotherapy.

Conclusions : Robotic platform seems to be as feasible as conventional laparoscopic approach for a left lateral sectionectomy. It provides two distinct advantages 1) utilising the inbuilt Firefly system in the DaVinci robotic platform and 2) laparoscopic assistant ports for using cost-effective liver transection energy devices for liver parenchymal transection in resource constraint settings.