机器人血管切除和重建是一项具有挑战性的手术。对于肝动脉无法重建的情况，门静脉动脉化 (PVA) 可以提供有效的解决方案。1.Can J Surg 64:e173-e182；2.Paul Brousse 医院经验。 HPB（牛津）16：723-738；3.J Am Coll Surg 207：e1-6； PVA 增加肝脏剩余部分的氧气供应，促进肝脏再生，并防止肝衰竭。Majlesara A、Golriz M、Ramouz A 等人。门静脉动脉化作为高级肝胰胆手术的挽救方法。 Br J Surg。 2024；111。在这篇多媒体文章中，我们描述了一位在机器人左肝优先前路根治性模块化原位右半肝切除术 (Rob-Larmorth) 中因机器人肝动脉损伤而接受 PVA 治疗的患者。5.Ann Surg Oncol 31:5636-5637 方法：一名 52 岁男性患者因上腹疼痛入院。进一步成像显示肝内胆管癌累及门静脉右前支根部。经过多学科会诊，建议手术切除作为主要方法。本次手术选择了机器人技术，术前预计需要 Rob-Larmorth。不幸的是，左肝动脉在十二指肠韧带骨架化过程中遭受了意外损伤。由于远端内膜损伤严重，无法进行吻合。我们利用PVA技术将肝动脉与门静脉吻合。最终，Rob-Larmorth 和 PVA 成功进行。手术持续了 490 分钟，预计失血量约为 300 mL。没有进行输血。 术后，患者恢复顺利，未出现肝功能衰竭，但因胆漏需要经皮引流。病理检查显示中度至低分化胆管细胞癌（T2N0M0，II期）。 12 个月的随访期间未观察到复发。当没有其他血运重建方案可用时，PVA 可能是一种有效的解决方案。 将 PVA 作为桥接程序可增加向残余肝脏的氧气输送，促进再生并降低肝衰竭的风险。动脉侧支循环的发展是接受 PVA 的患者最关心的问题。 PVA 后报告的并发症包括早期分流血栓形成、门静脉高压和显着的 90 天死亡率。1.Can J Surg 64:e173-e182 然而，Majlesara 及其同事没有发现与 PVA 相关的术后肝损伤的证据。他们还报告了动脉门静脉分流术的一期和两期栓塞的发病率较低，并且没有相关的死亡率。Majlesara A、Golriz M、Ramouz A 等人。门静脉动脉化作为高级肝胰胆手术的挽救方法。 Br J Surg。 2024;111.当肝动脉重建不可行时，PVA 可以提供有效的解决方案。© 2024。外科肿瘤学会。

Robotic vascular resection and reconstruction is a challenging procedure. Portal vein arterialization (PVA) can offer an efficient solution in those cases in which the hepatic artery cannot be reconstructed.1.Can J Surg 64:e173-e182;2.The Paul Brousse Hospital Experience. HPB (Oxford) 16:723-738;3.J Am Coll Surg 207:e1-6; PVA increases oxygen supply to the remaining part of the liver, promotes liver regeneration, and prevents liver failure.Majlesara A, Golriz M, Ramouz A, et al. Portal vein arterialization as a salvage method in advanced hepatopancreatobiliary surgery. Br J Surg. 2024;111. In this multimedia article, we describe a patient who was treated with PVA for a robotic hepatic artery injury during robotic left-liver-first anterior radical modular orthotopic right hemihepatectomy (Rob-Larmorth).5.Ann Surg Oncol 31:5636-5637 METHODS: A 52-year-old male patient was admitted with epigastric pain. Further imaging showed intrahepatic cholangiocarcinoma involving the root of the right anterior branch of the portal vein. Following multidisciplinary consultation, surgical resection was recommended as the primary approach. The robotic technique was chosen in this operation, with preoperative anticipation of needing Rob-Larmorth. Unfortunately, the left hepatic artery sustained unintended damage during skeletonization of the duodenal ligaments. Anastomosis could not be performed due to severe damage to the distal end intima. We utilized PVA technology to anastomose the hepatic artery to the portal vein. Finally, Rob-Larmorth and PVA were successfully performed.The surgery took 490 min and the estimated blood loss was approximately 300 mL. No blood transfusion was performed. Postoperatively, the patient recovered smoothly without liver failure, although percutaneous drainage was required due to bile leakage. Pathological examination revealed moderately to poorly differentiated bile duct cell carcinoma (T2N0M0, stage II). No recurrence was observed during the 12-month follow-up.PVA can be an effective solution when no other revascularization options are available. Implementing PVA as a bridging procedure increases oxygen delivery to the remnant liver, facilitating regeneration and reducing the risk of liver failure. The development of arterial collaterals is a significant concern for individuals undergoing PVA. Complications reported after PVA include early shunt thrombosis, portal hypertension, and a notable 90-day mortality rate.1.Can J Surg 64:e173-e182 However, Majlesara and colleagues found no evidence of postoperative liver damage associated with PVA. They also reported low morbidity rates and no associated mortality for both one- and two-stage embolization of the arterioportal shunt.Majlesara A, Golriz M, Ramouz A, et al. Portal vein arterialization as a salvage method in advanced hepatopancreatobiliary surgery. Br J Surg. 2024;111.PVA can offer an effective solution when hepatic artery reconstruction is not feasible.© 2024. Society of Surgical Oncology.