Robotic Resection of Right Perihilar Intrahepatic Cholangiocarcinoma: Practical Technique of Major Hepatic Resection for Biliary Tract Cancer.
Shivanshu Kumar, Maria Christodoulou, Iswanto Sucandy
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Case in brief
A 76-year-old woman with hepatic steatosis had a 5.5-cm centrally located intrahepatic cholangiocarcinoma near the hilum. Imaging and volumetric assessment were used to evaluate the future liver remnant. She underwent robotic right hepatectomy with formal portal lymphadenectomy, using early hilar dissection, inflow-first control, and low-pressure parenchymal transection. The operation was completed without a Pringle maneuver; blood loss was 150 mL. She had no perioperative complications and was discharged on postoperative day 5. Pathology showed poorly differentiated carcinoma with negative margins and no metastases in six lymph nodes. She remained disease free at one year.
What made this case unusual
The report demonstrates a structured robotic approach to major resection of a centrally located, juxtahilar tumor, including formal portal lymphadenectomy, in a patient with underlying hepatic steatosis.
Diagnostic / clinical pearl
For selected centrally located tumors considered for minimally invasive major hepatectomy, preoperative imaging and volumetric assessment of the future liver remnant are integral to operative planning.