Annals of Surgical Oncology

, Volume 21, Issue 6, pp 1841–1843 | Cite as

Totally Laparoscopic Right Hepatectomy with Roux-en-Y Hepaticojejunostomy for Right-Sided Intraductal Papillary Mucinous Neoplasm of the Bile Duct

  • Marcel Autran MachadoEmail author
  • Fabio F. Makdissi
  • Rodrigo C. Surjan
Hepatobiliary Tumors



Intraductal papillary neoplasm of the bile duct is a precursor lesion of cholangiocarcinoma. We present a video of a totally laparoscopic right hepatectomy with hilar dissection and lymphadenectomy, en-bloc resection of the extrahepatic bile duct, and Roux-en-Y hepaticojejunostomy in a patient with intraductal papillary neoplasm of the right hepatic duct.


A 58-year-old woman with right upper quadrant pain was referred for evaluation. Abdominal ultrasonography revealed dilatation of intrahepatic and extrahepatic bile ducts. Magnetic resonance imaging showed a stop in the right bile duct, with dilatation of the distal bile duct. The decision was to perform a totally laparoscopic right hepatectomy with hilar lymphadenectomy and Roux-en-Y hepaticojejunostomy.


The operative time was 400 min. Estimated blood loss was 400 ml, without the need for transfusions. Postoperative recovery was uneventful, and the patient was discharged on the 10th postoperative day. The abdominal drain was removed on the 14th postoperative drain with no signs of biliary leakage. Final pathology confirmed the diagnosis of intraductal papillary neoplasm without malignant transformation. Surgical margins were free. Patient is well with no evidence of the disease 14 months after the procedure.


Laparoscopic right hepatectomy with hepaticojejunostomy is feasible and safe, provided it is performed in a specialized center and with staff with experience in hepatobiliary surgery and advanced laparoscopic surgery. Currently this operation is reserved for selected cases. This video can help oncologic surgeons to perform this complex procedure.


Bile Duct Cholangiocarcinoma Hepatic Duct Intraductal Papillary Mucinous Neoplasm Extrahepatic Bile Duct 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Drs. Machado, Makdissi and Surjan have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 106047 kb)


  1. 1.
    Bickenbach K, Galka E, Roggin KK. Molecular mechanisms of cholangiocarcinogenesis: are biliary intraepithelial neoplasia and intraductal papillary neoplasms of the bile duct precursors to cholangiocarcinoma? Surg Oncol Clin N Am. 2009:18:215–24.PubMedCrossRefGoogle Scholar
  2. 2.
    Schlitter AM, Klöppel G, Esposito I. Intraductal papillary neoplasms of the bile duct (IPNB): diagnostic criteria, carcinogenesis and differential diagnostics. Pathologe. 2013;34(Suppl. 2):235–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Schlitter AM, Born D, Bettstetter M, et al. Intraductal papillary neoplasms of the bile duct: stepwise progression to carcinoma involves common molecular pathways. Mod Pathol. 2014;27:73–86.PubMedCrossRefGoogle Scholar
  4. 4.
    Yoon HJ, Kim YK, Jang KT, et al. Intraductal papillary neoplasm of the bile ducts: description of MRI and added value of diffusion-weighted MRI. Abdom Imaging. 2013;38:1082–90.PubMedCrossRefGoogle Scholar
  5. 5.
    Machado MA, Surjan RC, Makdissi FF. Intrahepatic Glissonian approach for pure laparoscopic right hemihepatectomy. Surg Endosc. 2011;25:3930–3.PubMedCrossRefGoogle Scholar
  6. 6.
    D’souza MA, Isaksson B, Löhr M, et al. The clinicopathological spectrum and management of intraductal papillary mucinous neoplasm of the bile duct (IPMN-B). Scand J Gastroenterol. 2013;48:473–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Naito Y, Kusano H, Nakashima O, et al. Intraductal neoplasm of the intrahepatic bile duct: clinicopathological study of 24 cases. World J Gastroenterol. 2012;18:3673–80.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Katabi N, Torres J, Klimstra DS. Intraductal tubular neoplasms of the bile ducts. Am J Surg Pathol. 2012;36:1647–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Kang MJ, Jang JY, Lee KB, Han IW, Kim SW. Impact of macroscopic morphology, multifocality, and mucin secretion on survival outcome of intraductal papillary neoplasm of the bile duct. J Gastrointest Surg. 2013;17:931–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Kubota K, Nakanuma Y, Kondo F, et al. Clinicopathological features and prognosis of mucin-producing bile duct tumor and mucinous cystic tumor of the liver: a multi-institutional study by the Japan Biliary Association. J Hepatobiliary Pancreat Sci. 2013. doi: 10.1002/jhbp.23.
  11. 11.
    Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection: 2,804 patients. Ann Surg. 2009;250:831–41.PubMedCrossRefGoogle Scholar
  12. 12.
    Machado MA, Makdissi FF, Surjan RC, Mochizuki M. Laparoscopic resection of hilar cholangiocarcinoma. J Laparoendosc Adv Surg Tech A. 2012;22:954–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Giulianotti PC, Sbrana F, Bianco FM, Addeo P. Robot-assisted laparoscopic extended right hepatectomy with biliary reconstruction. J Laparoendosc Adv Surg Tech A. 2010;20:159–63.PubMedCrossRefGoogle Scholar
  14. 14.
    Machado MA, Makdissi FF, Surjan RC, Machado MC. Laparoscopic pylorus-preserving pancreatoduodenectomy with double jejunal loop reconstruction: an old trick for a new dog. J Laparoendosc Adv Surg Tech A. 2013;23:146–9.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Marcel Autran Machado
    • 1
    Email author
  • Fabio F. Makdissi
    • 1
    • 2
  • Rodrigo C. Surjan
    • 1
    • 2
  1. 1.Department of SurgerySirio Libanes HospitalSão PauloBrazil
  2. 2.Department of GastroenterologyUniversity of São PauloSão PauloBrazil

Personalised recommendations