This operative video demonstrates a robotic right hepatic lobectomy with ultrasound-guided microwave ablationperformed for colorectal cancer liver metastases following systemic chemotherapy.

The patient is a 49-year-old woman with biopsy-proven microsatellite stable (MSS) sigmoid adenocarcinomainitially staged MRI T3N0 with PET/CT evidence of metastatic disease (M1) involving three hepatic lesions located in segments 2/4A, 5/6, and 8.

She completed 12 cycles of modified FOLFOX (mFOLFOX), achieving favorable systemic disease control. Restaging PET/CT demonstrated persistent metabolic activity limited to the segment 5/6 hepatic lesion and the rectosigmoid primary, with no evidence of additional metastatic disease.

Following multidisciplinary review and favorable restaging imaging, the patient underwent a staged minimally invasive surgical approach including:

• Robotic low anterior resection for sigmoid colon cancer

• Robotic staging laparoscopy

• Intraoperative hepatic ultrasound

• Ultrasound-guided microwave ablation of the segment 2/4A lesion

• Indocyanine green (ICG) cholangiography

• Robotic cholecystectomy

• Robotic right hepatic lobectomy

This approach allowed treatment of multifocal colorectal liver metastases using a combination of anatomic resection and targeted ablation, while preserving uninvolved hepatic parenchyma.

The patient recovered well following surgery and was discharged home on postoperative day three.

This case illustrates the integration of systemic therapy, advanced imaging, and robotic hepatobiliary surgery in the multidisciplinary management of colorectal liver metastases.

Learn more about Colon Cancer and Colorectal Liver Metastases.