Robotic Resection of Hilar Cholangiocarcinoma
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ORIGINAL ARTICLE – HEPATOBILIARY TUMORS
Robotic Resection of Hilar Cholangiocarcinoma Marcel Autran Machado, MD, FACS1,2, Bruno V. Mattos, MD2, Murillo Macedo Lobo Filho, MD2, and Fabio Makdissi, MD2 1
Department of Surgery, University of Sa˜o Paulo, Sa˜o Paulo, Brazil; 2Nove de Julho Hospital, Sa˜o Paulo, Brazil
ABSTRACT Background. Hilar cholangiocarcinoma is the most common malignant neoplasm of the biliary tract. Surgical resection is the only curative modality of treatment. The aim of this video is to present a robotic left hepatectomy extended to caudate lobe, combined with bile duct resection, lymphadenectomy, and Roux-en-Y biliary reconstruction. Methods. A 76-year-old female presented with progressive jaundice due to hilar cholangiocarcinoma. She underwent chemoradiation and after 5 months of treatment was referred for second opinion; imaging reevaluation showed objective response and no arterial invasion. Multidisciplinary team decided for radical treatment, which consisted in robotic left hepatectomy, caudate lobe resection, resection of bile duct, lymphadenectomy, and hepaticojejunostomy. Results. Operative time was 8 h. Estimated blood loss was 740 mL (received 2 U). The patient’s recovery was complicated by drainage clogging resulting in fever and perihepatic fluid collection, successfully treated by change of drainage. Pathology confirmed cholangiocarcinoma with free surgical margins (T1aN0). The patient is well, with no signs of disease 5 months after the procedure. Conclusions. Robotic resection of hilar cholangiocarcinoma is feasible and safe. The robotic approach has some technical advantages over laparoscopic approach. This
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-08514-6) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 8 February 2020 M. A. Machado, MD, FACS e-mail: [email protected]
video may help oncological surgeons to perform this complex procedure.
Hilar cholangiocarcinoma is the most common malignant neoplasm of the biliary tract. Surgical resection is the only curative modality of treatment. Liver resection combined with complete extrahepatic bile duct resection, lymphadenectomy, and biliary reconstruction represents the current standard surgical treatment.1, 2 Minimally invasive liver resection is a feasible and safe technique and has been used to treat several types of liver neoplasms.3, 4 Technical limitations and oncologic concerns have limited the adoption of minimally invasive techniques for the treatment of hilar cholangiocarcinoma.5-8 Since 2012, we have been using this approach.9, 10 The aim of this video is to present a robotic left hepatectomy extended to caudate lobe, combined with bile duct resection, lymphadenectomy, and Roux-en-Y biliary reconstruction. METHODS A 76-year-old female presented with progressive jaundice. Past medical history consisted of obesity and gastroesophageal reflux. She underwent laparoscopic cholecystecto
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