# Robot-assisted laparoscopic hepatectomy for hepatocellular carcinoma with Fontan-associated liver disease: a world-first case report

## TL;DR

This paper reports the first successful robot-assisted laparoscopic hepatectomy for liver cancer in a patient with Fontan-associated liver disease.

## Contribution

The first documented case of RALH for HCC in a patient with FALD, demonstrating its feasibility and safety under proper conditions.

## Key findings

- RALH was successfully performed with minimal blood loss and uneventful recovery.
- Thorough preoperative cardiac assessment and multidisciplinary collaboration ensured safety.
- The case suggests RALH can be considered for selected FALD patients with HCC.

## Abstract

Fontan-associated liver disease (FALD) encompasses hepatic complications following the Fontan procedure, ranging from fibrosis to hepatocellular carcinoma (HCC). Despite advancements in surgical techniques and perioperative care, robot-assisted laparoscopic hepatectomy (RALH) for HCC in patients with FALD has not been previously reported owing to concerns about the Fontan circulation.

We present the first case of RALH for recurrent HCC in a 45-year-old man after the Fontan procedure. The preoperative evaluation confirmed good cardiac function. The procedure involved meticulous monitoring and management of central venous pressure and was successfully completed with minimal blood loss. Postoperative recovery was uneventful. With thorough preoperative cardiac assessment and close collaboration between cardiologists and anesthesiologists, RALH can be safely performed in selected patients with FALD.

Even if a patient has a history of FALD, RALH can be safely performed in selected patients under appropriate conditions.