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Background <p>Recent innovations such as robotic platforms and liver venous deprivation (LVD) have the potential to improve the management and surgical treatment of peri-hilar cholangiocarcinoma (Ph-CCA). Robotic platforms integrate the operative field view with intraoperative ultrasound and preoperative 3D planning. <sup><CitationRef AdditionalCitationIDS="CR2 CR3" CitationID="CR1">1</CitationRef>–<CitationRef CitationID="CR4">4</CitationRef></sup> LVD is increasingly preferred over portal vein embolization for better liver hypertrophy outcomes in both speed and percentage.<sup><CitationRef CitationID="CR5">5</CitationRef></sup> This video demonstrates the feasibility of fully robotic right hepatectomy with common bile duct resection and reconstruction for Ph-CCA after LVD.</p> Patients <p>A Bismuth 3a Ph-CCA was diagnosed in a 74-year-old female with jaundice. Preoperatively, the patient underwent 3D volumetry and planning and percutaneous drainage of left biliary ducts. The future remnant liver volume increased from 38 to 53% of total liver volume after LVD.</p> Technique <p>Four robotic trocars and one laparoscopic port were placed, and the da Vinci Xi system was docked. En-bloc regional lymphadenectomy was performed, followed by isolation of the hepatic pedicle elements. After mobilization of the caudate lobe and section of the distal common bile duct, the en-bloc right hepatectomy was carried out. A single biliodigestive anastomosis was performed on B2-3-4 on an antecolic Roux-&amp;-Y jejunal loop. The operative time was 810 min. The blood loss was 500 mL. The patient was discharged on postoperative day 16. The pathology confirmed pT2b N0 (0/11 nodes) R0r R0b<sup><CitationRef CitationID="CR6">6</CitationRef>,<CitationRef CitationID="CR7">7</CitationRef></sup> G2 Ph-CCA.</p> Conclusion <p>Although this was a very demanding and challenging approach for both the patient and the surgical team, this video demonstrates the feasibility of this management and probably sets the goal for a new standard of care.</p>

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Robotic Right Hepatectomy for Peri-Hilar Cholangiocarcinoma after Liver Venous Deprivation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月1日

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  • Simone Conci,
  • Giuseppe Calderone,
  • Andrea Ruzzenente

摘要

Background

Recent innovations such as robotic platforms and liver venous deprivation (LVD) have the potential to improve the management and surgical treatment of peri-hilar cholangiocarcinoma (Ph-CCA). Robotic platforms integrate the operative field view with intraoperative ultrasound and preoperative 3D planning. 1–4 LVD is increasingly preferred over portal vein embolization for better liver hypertrophy outcomes in both speed and percentage.5 This video demonstrates the feasibility of fully robotic right hepatectomy with common bile duct resection and reconstruction for Ph-CCA after LVD.

Patients

A Bismuth 3a Ph-CCA was diagnosed in a 74-year-old female with jaundice. Preoperatively, the patient underwent 3D volumetry and planning and percutaneous drainage of left biliary ducts. The future remnant liver volume increased from 38 to 53% of total liver volume after LVD.

Technique

Four robotic trocars and one laparoscopic port were placed, and the da Vinci Xi system was docked. En-bloc regional lymphadenectomy was performed, followed by isolation of the hepatic pedicle elements. After mobilization of the caudate lobe and section of the distal common bile duct, the en-bloc right hepatectomy was carried out. A single biliodigestive anastomosis was performed on B2-3-4 on an antecolic Roux-&-Y jejunal loop. The operative time was 810 min. The blood loss was 500 mL. The patient was discharged on postoperative day 16. The pathology confirmed pT2b N0 (0/11 nodes) R0r R0b6,7 G2 Ph-CCA.

Conclusion

Although this was a very demanding and challenging approach for both the patient and the surgical team, this video demonstrates the feasibility of this management and probably sets the goal for a new standard of care.