Robotic Klatskin Tumor Type 3b Resection

Whiyie Sang, MD

Product Details
Product ID: ACS-6113
Year Produced: 2020
Length: 10 min.


This video depicts resection of hilar cholangiocarcinoma involving the biliary bifurcation and the right hepatic duct, extending into the right hemi liver, undertaken in a 74-year-old man.Portal dissection and lymphadenectomy was undertaken. The common hepatic artery, common bile duct, and the periportal lymph nodes were identified, excised, and sent to pathology for frozen sections. The bile duct was skeletonized down to the head of the pancreas. Utilizing the robotic monopolar scissor cautery, the distal common duct was transected. A 4-0 polypropylene suture was used to close the distal part of the common bile duct. Right total hepatic lobectomy was executed after examination of intrahepatic vasculature using the robotic ultrasound. The right hepatic vien and portal vein were isolated and transected. The left hepatic duct was transected, and the final margin was confirmed to be negative for malignancy. The caudate lobe was mobilized off the inferior vena cava and included in the resection. A linear stapler was utilized to transect the right hepatic vein and the specimen was detached from the liver remnant. To begin the reconstruction, the ligament of Treitz was identified and the proximal jejunum was transected utilizing a robotic load stapler. A side-to-side stapled jejunojejunostomy was created. A 60cm Roux limb was constructed and transposed to the porta hepatis for the construction of the right Roux-en-Y hepaticojejunostomy. An end-to-side right-sided hepaticojejunostomy was completed utilizing the running V-Loc sutures. The anastomosis was buttressed with the omental flap. A JP drain was placed.