The robotic-assisted approach for left-side predominance hilar cholangiocarcinoma: a video technique
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LETTER TO THE EDITOR
The robotic‑assisted approach for left‑side predominance hilar cholangiocarcinoma: a video technique Marco Vito Marino1,2 · Gianluca Pellino3,4 · Ali Ahmad5 Received: 20 March 2020 / Accepted: 16 April 2020 © Italian Society of Surgery (SIC) 2020
Keywords Robotic liver surgery · Hilar cholangiocarcinoma · Video-technique Dear Editor-in-Chief Professor Fulvio Calise First reported in 2002, the application of robotic liver surgery is progressively gaining momentum among the HPB surgical community [1, 2]. The initial experience from high volume centers already demonstrated its safety, feasibility and oncologic adequacy when compared to the open counterpart [3]. The enhanced visualization and the endowrist instrumentation of the robotic platform increased the number of parenchymal sparing liver resections even for lesions located in complex areas as the posterio-superior segments or the caudate lobe [4]. The minimally invasive approach for hilar cholangiocarcinoma is currently scarcely reported [5]; the concerns about the oncologic adequacy, the significant risk of intraoperative bleeding and the advanced suturing skills required for the restoration of the biliary tract continuity limited its worldwide adoption [6]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13304-020-00777-8) contains supplementary material, which is available to authorized users. * Marco Vito Marino [email protected] 1
General Surgery Department, Hospital Universitario Marques de Valdecilla, Santander, Cantabria, Spain
2
Emergency and General Surgery Department, Azienda Ospedaliera, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
3
General Surgery Department, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
4
Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
5
Surgical Oncology Department, University of Kansas, School of Medicine-Wichita, Kansas, USA
In this context, the capabilities of the robotic system and the software for the indocyanine green (Firefly™ mode) can be of assistance in these challenging scenarios which requires meticulous dissection and microsuturing [7]. In this video, we demonstrated a robotic-assisted approach for a perihilar cholangiocarcinoma of the left-side predominance (Bismuth type IIIB). A 57-year-old-man patient complained of abdominal pain and jaundice. His serum bilirubin level was 5.2 mg/dL. He was admitted to our hospital, and he underwent CT-scan and cholangiography which indicated the presence of hilar cholangiocarcinoma with predominant left hepatic duct involvement. Before induction of general anaesthesia, a 2.5 mg dose of indocyanine green (ICG) was injected in a peripheral venous access. Complete mobilization of the left hemiliver including the caudate lobe was performed of the inferior vena cava at the beginning. Subsequently, regional lymphadenectomy along the common and proper hepatic arteries (station number 8) was carried out with complete skeletoniz
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