Robotic Right Trisectionectomy, Main Biliary Confluence Resection, Lymphadenectomy, and Hepaticojejunal Reconstruction for Perihilar Cholangiocarcinoma
摘要
Surgical resection of perihilar cholangiocarcinoma (PHC) remains the only curative treatment.
A 63-year-old woman with no significant past medical history was diagnosed with PHC following incidental cholestasis discovery. Magnetic resonance imaging and computed tomography revealed a 20-mm Bismuth–Corlette type IIIa PHC, confirmed as well-differentiated on endobiliary biopsy. Preoperative right portal vein embolization enabled future left lobe volume optimization (39% of total liver volume).
ResultsA robot-assisted right trisectionectomy with main biliary confluence resection (H145678-B), lymphadenectomy (stations 7, 8, 9, 12, 13), and hepaticojejunal reconstruction was performed using the Da Vinci Xi® system and a standard multiport configuration (four 8 mm robotic trocars and one 12 mm assistant trocar). Operative time was 400 minutes, and blood loss was 150 mL. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 5 after drain removal. Histopathology confirmed a well-differentiated pT1N0(0/13)M0R0 PHC.
ConclusionsThis case demonstrates the feasibility and safety of robot-assisted extended hepatectomy with biliary reconstruction for PHC in a highly selected patient. Robotic assistance may facilitate precise dissection and reconstruction in the hilum, supporting broader adoption in expert centers pending further comparative data.