Robotic Taj Mahal Hepatectomy for Hilar Cholangiocarcinoma

Abstract

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract.Radical surgical resection is the only effective treatment option. In this study, a 32year-old male patient with Bismuth Type IVa hilar cholangiocarcinoma underwent radical robotic resection of hepatic S4b, S5, and S1 (Taj Mahal hepatectomy) combined with regional lymphadenectomy, hilar bile duct reconstruction, and hepaticojejunostomy by the robotic surgical system. Postoperative pathological examination showed moderately-differentiated adenocarcinoma of the hilar bile duct.The surgical margins of the liver and bile ducts were negative. Recovery was smooth and the patient was discharged on the 17 th postoperative day. The robotic surgical system and associated multiple instruments along with flexible and precise movements is suitable for the local hepatectomy around the porta hepatis, and delicate reconstruction of the hilar bile duct with a smaller diameter. This first clinical application study found that robotic Taj Mahal hepatectomy for hilar cholangiocarcinoma is safe and feasible and needs more experience for the evaluation of its long-term outcomes.

Robotic Hepatectomy plus Biliary Reconstruction for Bismuth Type III and Type IV Hilar Cholangiocarcinoma: State of the Art and Literature Review

“…Sixteen manuscripts were subsequently excluded for the various reasons including inconsistencies in the population, disease, surgical approach or outcomes for III-IV HC. Ultimately, we included a total of 12 papers [12][13][14][15][16][17][18][19][20][21][22][23], reporting the outcomes of 50 patients, in this review (Figure 1). Nine of these papers are case reports, while three are retrospective single-center experience, with the largest series consisting of 28 patients.…”

“…The initial literature research yielded 73 English papers. After removing dup and screening titles and abstract, we assessed 28 studies through full-text eva Sixteen manuscripts were subsequently excluded for the various reasons in inconsistencies in the population, disease, surgical approach or outcomes for III-Ultimately, we included a total of 12 papers [12][13][14][15][16][17][18][19][20][21][22][23], reporting the outcomes of 50 p in this review (Figure 1). Nine of these papers are case reports, while th retrospective single-center experience, with the largest series consisting of 28 pat this largest series, 48 cases were described, but we excluded 20 cases that were B types I and II and underwent only biliary resection.…”

“…The type of surgical intervention depended on the pattern of intra-ductal tumor' growth and included left or right hepatectomy or bi-segmentectomy (Taj Mahal procedure, described only in one article), plus segment I resection and hilar lymphadenectomy. The reconstructive phase involved Roux-en-Y bilio-enteric anastomosis, with only four authors [19][20][21][22][23] reporting more than one bile duct anastomosis (mean 2.12 ductal anastomosis). The operative time was extracted in 92% of cases, and considering all case reports and two case series, the mean operative time was 500 minutes.…”

“…On the other hand, the Taj Mahal procedure requires two plains to remove these liver segments, as well as the dissection of the hepatic artery and portal vein using an intra-Glissonian approach. This option is seldom reported, but Deng et al also described the utility of the robot also for Taj Mahal procedure [23], confirming that it offers a further option in selected cases to perform minimally invasive hepaticojejunostomies even when multiple ducts are present.…”