Robotic Resection of Type I Hilar Cholangiocarcinoma with Intrapancreatic Bile Duct Dissection

Abstract

Background. Type I hilar cholangiocarcinoma is a malignancy of the extrahepatic bile duct for which marginnegative resection with sufficient lymphadenectomy may provide curative treatment. The aim of this video is to highlight the advantages of optical magnification, articulating instruments, and indocyanine green fluorescent cholangiography to demonstrate extrahepatic bile duct resection from the biliary confluence to the intrapancreatic bile duct with comprehensive hilar lymphadenectomy for pathologic staging. Methods. A 58-year-old male presented with obstructive jaundice and was found to have a biliary stricture arising from the cystic duct and bile duct junction. Endoscopic biopsy of the bile duct confirmed adenocarcinoma. His case was presented at a multidisciplinary tumor conference where consensus was to proceed with upfront robotic en bloc extrahepatic bile duct resection with hilar lymphadenectomy and Roux-en-Y hepaticojejunostomy. Results. Final pathology demonstrated margin-negative resection of moderately differentiated adenocarcinoma, 1 out of 12 lymph nodes involved with disease, and pathologic stage T2N1M0 (stage IIIC). The patient had no postoperative complications and was discharged home on postoperative day 5. At 6 weeks from his operative date, he was initiated on four cycles of adjuvant gemcitabine/capecitabine, followed by 50 Gray external beam radiation therapy with capecitabine, then four cycles of gemcitabine/capecitabine, completed after 6 months of therapy. Conclusions. Robotic extrahepatic bile duct resection, hilar lymphadenectomy, and biliary enteric reconstruction is feasible and should be considered for selected cases of bile duct resection.

Robotic Surgery for Biliary Tract Cancer

“…All reviewers approved of the final set of included studies. In total, 11 studies reported data on 146 patients undergoing robotic surgery for cholangiocarcinoma (CC) [ 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ], and 10 studies reported data on 113 patients undergoing robotic surgery for gallbladder cancer (GBC) [ 6 , 15 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

“…The most common procedure was a biliary resection with lymphadenectomy and hepaticojejunostomy (36%); followed by hepatectomy with biliary resection, lymphadenectomy, and biliary reconstruction (29%); hepatic resection without biliary intervention (16%); biliary resection with alternate reconstruction or diversion (15%); and unspecified (4%). Only one study reported the intraoperative use of indocyanine green [ 9 ]. One study reported the use of intraoperative cholangioscopy to facilitate extent of biliary resection [ 10 ].…”

The role of robotic surgery for the treatment of hilar cholangiocarcinoma: A systematic review

“…Due to inconsistencies in population, disease, surgical approach, or outcomes, 14 records were removed following full-text screening. The remaining 12 studies ( 10 – 21 ) were included in the quantitative synthesis of this systematic review. Eight case reports (10, 12, 14, 16, 17, and 19-21) and four case series (11, 13, 15, and 18) describing only single-center RS experiences for HC were selected.…”

Indocyanine green (ICG) fluorescence in robotic hepatobiliary surgery: A systematic review

“…In addition, various case reports suggest that ICG cholangiography helps identify aberrant biliary anatomy, providing further guidance in unexpectedly difficult procedures. [37][38][39][40][41][42] The enhanced anatomic vis- Although data regarding bile duct injury is mixed, 43 future studies would be remiss in not stratifying procedures by use of ICG cholangiography when possible. Pooling these data when subgroup analysis is available would risk eliminating the effect size produced by the improved extrahepatic biliary tree visualisation provided by routine fluorescence imaging.…”