Background Open surgery for hilar cholangiocarcinoma (HCCA) has already been widely reported and analyzed. However, the laparoscopic technique for treating HCCA remains controversial because of the lack of radicality and poor assessment of the resectability of hilar structures without direct palpation. The aim of this study was to provide detailed surgical procedures and photographs of this technically demanding operation, describe our experience in assessing resectability before and during surgery, and confirm the radicality of laparoscopic resection of Bismuth type III and IV HCCA. Methods From November 2016 to November 2018, nine patients received laparoscopic resection of Bismuth type III or IV HCCA in our department. Results Laparoscopic right hepatectomy was performed in four patients, and laparoscopic left hepatectomy was performed in five patients. Negative margins were achieved in all patients. Complications were found in two (22.22%) patients, with bile leakage and hepatic insufficiency each in one patient. The patient developing hepatic insufficiency had persistent and ongoing liver failure and finally expired. Conclusion The radicality of laparoscopic resection for Bismuth type III and IV HCCA can be technically improved through extended lymphadenectomy, visual assessment of hilar structures, and frozen section techniques.

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Objective. To investigate the clinical value of hepatectomy based on minimally invasive surgical images in the treatment of hepatolithiasis. Methods. The clinical data of 87 patients with hepatolithiasis who received treatment in the Department of General Surgery of our hospital from February 2020 to September 2021 were retrospectively analyzed. According to different surgical methods, the patients were divided into minimally invasive group (n = 43) and laparotomy group (n = 44). Perioperative conditions and stone clearance rate were compared. Results. The preoperative conditions of patients in the two groups were comparable, and the average operation time in the minimally invasive group was significantly longer than that in the laparotomy group (t = 18.783, P < 0 . 0 0 1 ). There was no significant difference in intraoperative bleeding, postoperative fasting time, postoperative complications, and stone clearance between the two groups ( P > 0 . 0 5 ). Postoperative hospital stay was significantly lower in the minimally invasive group than that in the laparotomy group (t = −0.486, P < 0 . 0 0 1 ). Conclusion. Hepatectomy based on minimally invasive surgical imaging for hepatolithiasis is safe and feasible, has high clinical value, and can achieve similar short-term clinical efficacy to laparotomy and reduce the postoperative hospital stay of patients, reflecting its minimally invasive advantages, and it is worthy of clinical application.