Abstract
Perihilar cholangiocarcinoma (Klatskin tumor) is one of the most challenging hepatobiliary cancers to treat due to its critical location and tendency to involve nearby vascular structures in the portal hepatic. A combined biliary and major liver resection is often required to achieve a complete oncological resection. Traditionally, Klatskin tumor resection is performed using an “open” approach until recently when the minimally invasive technique becomes popular due to its proven advantages. The laparoscopic technique had been reported; however, the majority of resections were types I and II without the need for ipsilateral hepatectomy. Inherent limitations of straight laparoscopic instruments result in significant technical difficulties in performing precise tissue dissection and vessel repair and creating a fine bilioenteric anastomosis. In this didactical video, we described our technique of type IIIB Klatskin tumor (B3-L perihilar cholangiocarcinoma) resection utilizing a robotic technology. The use of a robotic platform facilitates precise porta hepatic dissection, bleeding control, and creation of a fine bilioenteric anastomosis at the level of the hilar plate. We believe that the robotic platform provides an alternative method for resection of perihilar cholangiocarcinoma with excellent short-term outcomes.
Similar content being viewed by others
References
Hu HJ, Wu ZR, Jin YW, et al. Minimally Invasive Surgery for Hilar Cholangiocarcinoma: State of Art and Future Perspectives. ANZ J Surg. 2019 May;89(5):476-480.
Lee W, Han HS, Yoon YS, et al. Laparoscopic Resection of Hilar Cholangiocarcinoma. Ann Surg Treat Res. 2015 Oct;89(4):228-32.
Li J, Zhao L, Zhang J, Li Z, Li A, Wei Y, Xu J. Application of the Laparoscopic Technique in Perihilar Cholangiocarcinoma Surgery. Int J Surg. 2017 Aug;44:104-109.
Deoliveira ML, Schulick RD, Nimura Y, Rosen C, Gores G, Neuhaus P, Clavien PA. New staging system and a registry for perihilar cholangiocarcinoma. Hepatology. 2011 Apr;53(4):1363-71. doi: https://doi.org/10.1002/hep.24227.
Acknowledgment
Emily Krill, BS, and Miguel Castro, BS, for their contributions in technical video editing
Author information
Authors and Affiliations
Contributions
Iswanto Sucandy, Alexander Rosemurgy, and Sharona Ross provided substantial contributions to the conception and design of the study. Iswanto Sucandy provided substantial contributions in the manner of data acquisition, analysis, and interpretation of the data for the manuscript. All authors participated in drafting the manuscript and provided critical revisions for important intellectual content. All authors agree to be accountable for all aspects of the work and are confident in the integrity of the contributions of co-authors.
Corresponding author
Ethics declarations
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Patient Consent
All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict of Interest
Authors Alexander Rosemurgy and Sharona Ross are proctors Intuitive Surgical Inc. (Intuitive Corporation, Sunnyvale, CA). Iswanto Sucandy has no disclosures/conflicts of interest to report.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Oral Presentation during the 2020 Americas Hepatopancreatobiliary Association (AHPBA) in Miami Beach, Florida (March 5-8, 2020)
Supplementary Information
(MP4 287177 kb)
Rights and permissions
About this article
Cite this article
Sucandy, I., Ross, S. & Rosemurgy, A. Robotic Resection of a Type IIIB Klatskin Tumor. J Gastrointest Surg 25, 1939–1940 (2021). https://doi.org/10.1007/s11605-021-04968-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-021-04968-5