Minimally invasive surgery for hilar cholangiocarcinoma: state of art and future perspectives

Abstract

Minimally invasive surgery for HCCA is restricted to highly selected cases and is deemed technically achievable in experienced hands. However, technical and instrumental improvement is needed to reduce the relevant morbidity and popularize the use of minimally invasive surgery to treat HCCA.

International consensus statement on robotic hepatectomy surgery in 2018

“…The meta-analyses published by Qiu et al[72] and Montalti et al[73] had also drawn similar conclusions. In addition, the meta-analysis published by Hu et al[74] in 2018 that analyzed the efficacy of robotic surgery in liver tumors also obtained similar conclusions. The analysis also found that the robotic group had a longer postoperative fasting time (weighted MD = 1.2, 95%CI: 0.24, 2.17), but the two groups showed no significant difference postoperative mortality (OR = 0.67, 95%CI: 0.16, 2.83).…”

Initial single institution experience with robotic biliary surgery and bilio‐enteric anastomosis in southeast Asia

“…[14][15][16][17]20 Hence, many surgeons still elect to approach these procedures via the traditional open approach. Presently, with advancements in surgical technique and technology, increasing reports of laparoscopic bilio-enteric anastomosis for various indications such as choledochal cysts and bile duct cancers, [10][11][12]22 have been reported in the literature. Although good results with bilio-enteric anastomosis have been reported with conventional laparoscopy by high-volume expert surgeons, 10,33 questions remain about the transferability of these results.…”

“…13,14 However, its use is mainly limited to relatively straightforward conditions such as biliary colic, symptomatic gallstones and early acute cholecystitis. The use of the laparoscopic approach for even more complicated major biliary surgeries such as for gallbladder cancer, [19][20][21] choledochal cysts, 9,10,12 bile duct cancers 22 and bile duct injuries 23 remain highly limited and is largely performed in a selected few high-volume specialized centres. The use of the laparoscopic approach for even more complicated major biliary surgeries such as for gallbladder cancer, [19][20][21] choledochal cysts, 9,10,12 bile duct cancers 22 and bile duct injuries 23 remain highly limited and is largely performed in a selected few high-volume specialized centres.…”

“…13,14 When applied to more complicated conditions such as perforated/gangrenous cholecystitis, 15 choledocholithiasis 16 and Mirizzi syndrome, 17,18 the laparoscopic approach has been reported to be associated with high open conversion rates of up to 70%. The use of the laparoscopic approach for even more complicated major biliary surgeries such as for gallbladder cancer, [19][20][21] choledochal cysts, 9,10,12 bile duct cancers 22 and bile duct injuries 23 remain highly limited and is largely performed in a selected few high-volume specialized centres.…”

“…These advantages of the robotic platform allow more precise dissection and suturing in narrow spaces which in theory would be especially useful for complex biliary surgery in the hepatic hilar region. 24,25 Hence, robotic biliary surgery (RBS) has been adopted by several expert centres as an alternative MIS approach for major biliary procedures such as for hepaticojejunostomies, 8,9,23 repair of bile duct injuries 26 and resections for gallbladder cancer. 21 However, to date studies specifically reporting on RBS remain very limited worldwide.…”