Robotic Approach for Perihilar Cholangiocarcinoma IIIA Type: Step-by-Step Procedure.
Cholangiocarcinoma
Hepatectomy
Klatskin hilar cholangiocarcinoma
Robotic
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
05 Feb 2024
05 Feb 2024
Historique:
received:
03
10
2023
accepted:
10
01
2024
medline:
5
2
2024
pubmed:
5
2
2024
entrez:
5
2
2024
Statut:
aheadofprint
Résumé
Perihilar cholangiocarcinoma is a challenging technique to be performed by minimally invasive approach being the type III among the most complex procedure. Nowadays, the robotic approach is gaining increasing interest among the surgical community, and more and more series describing robotic liver resection have been reported. However, few cases of minimally invasive Bismuth type IIIA cholangiocarcinoma have been reported. Robotic approach allows for a better dissection and suture thanks to the flexible and precise instruments movements, overcoming some of the limitations of the laparoscopic technique. Therefore, robotic technique can facilitate some of the critical steps of a technically demanding procedure, such as the extended right hepatectomy for perihilar cholangiocarcinoma Bismuth IIIA type. In this multimedia video we describe, for the first time in the literature, a full robotic surgical step-by-step technique with some tips and tricks for treating a perihilar cholangiocarcinoma Bismuth IIIA type, performing a radical extended right hemihepatectomy, including segment I combined with regional lymphadenectomy anf left bile duct reconstruction. A 55-year-old woman with obstructive jaundice (10 mg/dl) was referred to our center. The endobiliary brushing confirmed adenocarcinoma, and MRI/CT showed a focal perihilar lesion of 2 cm, including the main biliary duct bifurcation and extending up to the right duct (Bismuth Type IIIA hilar cholangiocarcinoma). After endoscopic biliary stents placement and 6 weeks after right portal vein embolization, the future liver remnant, including segments II and III, reached an enough hypertrophy volume with a ratio of 30%. A right hemihepatectomy with caudate lobe, including standard standard lymphadenectomy and left biliary duct reconstruction was performed. The operation lasted 670 min with an estimated blood loss of 350 ml. Postoperative pathological examination revealed a moderately differentiated adenocarcinoma pT1N0 with 15 retrieved nodes and free margins. The patient experienced a type A biliary fistula and was discharged on the 21st postoperative day without abdominal drainage. Through the tips and tricks presented in this multimedia article, we show the advantages of the robotic approach for performing correctly one of the most complex surgeries.
Sections du résumé
BACKGROUND
BACKGROUND
Perihilar cholangiocarcinoma is a challenging technique to be performed by minimally invasive approach being the type III among the most complex procedure. Nowadays, the robotic approach is gaining increasing interest among the surgical community, and more and more series describing robotic liver resection have been reported. However, few cases of minimally invasive Bismuth type IIIA cholangiocarcinoma have been reported. Robotic approach allows for a better dissection and suture thanks to the flexible and precise instruments movements, overcoming some of the limitations of the laparoscopic technique. Therefore, robotic technique can facilitate some of the critical steps of a technically demanding procedure, such as the extended right hepatectomy for perihilar cholangiocarcinoma Bismuth IIIA type.
METHODS
METHODS
In this multimedia video we describe, for the first time in the literature, a full robotic surgical step-by-step technique with some tips and tricks for treating a perihilar cholangiocarcinoma Bismuth IIIA type, performing a radical extended right hemihepatectomy, including segment I combined with regional lymphadenectomy anf left bile duct reconstruction. A 55-year-old woman with obstructive jaundice (10 mg/dl) was referred to our center. The endobiliary brushing confirmed adenocarcinoma, and MRI/CT showed a focal perihilar lesion of 2 cm, including the main biliary duct bifurcation and extending up to the right duct (Bismuth Type IIIA hilar cholangiocarcinoma). After endoscopic biliary stents placement and 6 weeks after right portal vein embolization, the future liver remnant, including segments II and III, reached an enough hypertrophy volume with a ratio of 30%. A right hemihepatectomy with caudate lobe, including standard standard lymphadenectomy and left biliary duct reconstruction was performed.
RESULTS
RESULTS
The operation lasted 670 min with an estimated blood loss of 350 ml. Postoperative pathological examination revealed a moderately differentiated adenocarcinoma pT1N0 with 15 retrieved nodes and free margins. The patient experienced a type A biliary fistula and was discharged on the 21st postoperative day without abdominal drainage.
CONCLUSIONS
CONCLUSIONS
Through the tips and tricks presented in this multimedia article, we show the advantages of the robotic approach for performing correctly one of the most complex surgeries.
Identifiants
pubmed: 38315334
doi: 10.1245/s10434-024-14956-z
pii: 10.1245/s10434-024-14956-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
Hewitt DB, Brown ZJ, Pawlik TM. current perspectives on the surgical management of perihilar cholangiocarcinoma. Cancers. 2022;14(9):2208.
doi: 10.3390/cancers14092208
pubmed: 35565335
pmcid: 9104954
Berardi G, Lucarini A, Colasanti M, Mariano G, Ferretti S, Meniconi RL, Guglielmo N, Angrisani M, Usai S, Borcea MC, Canali G, Moschetta G, Ettorre GM. Minimally invasive surgery for perihilar cholangiocarcinoma: a systematic review of the short- and long-term results. Cancers. 2023;15(11):3048.
doi: 10.3390/cancers15113048
pubmed: 37297010
pmcid: 10252826
Franken LC, van der Poel MJ, Latenstein AEJ, Zwart MJ, Roos E, Busch OR, Besselink MG, van Gulik TM. Minimally invasive surgery for perihilar cholangiocarcinoma: a systematic review. J Robot Surg. 2019;13(6):717–27.
doi: 10.1007/s11701-019-00964-9
pubmed: 31049774
pmcid: 6842355
Xu Y, Wang H, Ji W, Tang M, Li H, Leng J, Meng X, Dong J. Robotic radical resection for hilar cholangiocarcinoma: perioperative and long-term outcomes of an initial series. Surg Endosc. 2016;30(7):3060–70.
doi: 10.1007/s00464-016-4925-7
pubmed: 27194255
Hartog H, Ijzermans JN, van Gulik TM, Groot-Koerkamp B. Resection of perihilar cholangiocarcinoma. Surg Clin N Am. 2016;96(2):247–67.
doi: 10.1016/j.suc.2015.12.008
pubmed: 27017863
Quijano Y, Vicente E, Ielpo B, Duran H, Diaz E, Fabra I, Olivares S, Ferri V, Ortega I, Malavé L, Ferronetti A, Piccinni G, Caruso R. Robotic liver surgery: early experience from a single surgical center. Surg Laparosc Endosc Percutan Tech. 2016;26(1):66–71.
doi: 10.1097/SLE.0000000000000227
pubmed: 26836628
Cipriani F, Ratti F, Fiorentini G, Reineke R, Aldrighetti L. Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma. Updates Surg. 2021;73(2):359–77.
doi: 10.1007/s13304-021-01006-6
pubmed: 33615423