Francesco Maria Bianco, MD; Fabio Sbrana, MD; Pietro Addeo, MD; Mark S. Choh, MD; Galaxy Shah, MD; Pier Cristoforo Giulianotti, MD
Surgical resection represents the only curative treatment for biliary tract cancer. Right extended hepatectomy combined with extrahepatic bile duct resection and radical lymphadenectomy represents the treatment of choice for hilar cholangiocarcinoma involving biliary bifurcation and extending into the right segmental branches (Bismuth Type IIIA). Robotic surgery has been recently applied to liver surgery.
A 66 year old patient with Type IIIA hilar cholangiocarcinoma was referred to our unit for surgery. The patient previously underwent a biliary percutaneous drainage followed by right portal vein embolization allowing satisfactory left liver remnant volume. He then received a robotic-assisted right hepatectomy extended to the segment IV with extrahepatic bile duct resection, lymphadenectomy and Roux-En-Y intrahepatic bilio-jejunostomy.
The procedure was completed robotically with no conversion and no intraoperative morbidity. Operative time was 540 minutes. Estimated blood loss were 1000cc. The postoperative course was uneventful and the patient was discharged on postoperative day 8.
Robotic extended right hepatectomy with extrahepatic bile duct resection and Roux-En-Y intra-hepatic bilio jejunostomy for hilar cholangiocarcinoma is feasible. Robotic assistance allows a complete lymphadenectomy and an easier biliary reconstruction. The minimally invasive approach improves the patient compliance in terms of postoperative pain, faster recovery and shorter delay to adjuvant therapies.