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Robotic Right Hepatectomy with Caudate Lobectomy for Hilar Cholangiocarcinoma
Case description
Robotic right hepatectomy with caudate lobectomy for hilar cholangiocarcinoma; Kalayarasan Raja, Department of Surgical Gastroenterology, JIPMER, Puducherry.
Introduction: Major hepatectomy for hilar cholangiocarcinoma is one of the most challenging abdominal procedures. A minimally invasive approach is not commonly used as it involves complex hilar dissection and reconstruction. Also, in the few published reports, minimally invasive right hepatectomy and caudate lobectomy were performed separately. We present the technique of robotic right hepatectomy with enbloc caudate lobectomy for type IIIa hilar cholangiocarcinoma.
Case details: 52-year male presented with jaundice and pruritus. Imaging revealed type IIIa hilar cholangiocarcinoma. Following percutaneous transhepatic biliary drainage (PTBD) of the left and right posterior hepatic duct, serum bilirubin level reduced from 26mg/dL to 4.66 mg/dL. Future liver remnant volume was 42%.
Methods: The key steps of the procedure are standard lymphadenectomy followed by bile duct transected distally and dissected cranially. The right portal vein and hepatic artery were divided, and the line of demarcation was identified using indocyanine green fluorescence. Liver transection was done by the crush clamping method using robotic bipolar instruments. After complete mobilization of the caudate lobe, it was brought to the right of the inferior vena cava. The left hepatic duct was transected to the right of the umbilical fissure. The right liver with caudate was resected en-bloc after the right hepatic vein was divided. Roux-en-Y cholangiojejunostomy (S2+3 and S4) was done.
The patient had an uneventful postoperative course and was discharged on the seventh postoperative day. R0 resection confirmed on histopathology.
Conclusion: Robotic right hepatectomy with en-bloc caudate lobectomy is safe and feasible in selected patients.
