Robotic Resection of Hilar Cholangiocarcinoma



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.


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.


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.


Robotic resection of hilar cholangiocarcinoma is feasible and safe. The robotic approach has some technical advantages over laparoscopic approach. This video may help oncological surgeons to perform this complex procedure.

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  1. 1.

    Mansour JC, Aloia TA, Crane CH, et al. Hilar cholangiocarcinoma: expert consensus statement. HPB (Oxford). 2015;17:691–99.

    PubMed Central  Google Scholar 

  2. 2.

    Poruk KE, Pawlik TM, Weiss MJ. Perioperative management of hilar cholangiocarcinoma. J Gastrointest Surg. 2015;19:1889–99.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Ciria R, Cherqui D, Geller DA, et al. Comparative short-term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg. 2016;263:761–77

    PubMed  Google Scholar 

  4. 4.

    Tsung A, Geller DA, Sukato DC, et al. Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg. 2014;259:549–55.

    PubMed  Google Scholar 

  5. 5.

    Wakabayashi G, Cherqui D, Geller DA, et al. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 2015;261:619–29.

    PubMed  Google Scholar 

  6. 6.

    Liu R, Wakabayashi G, Kim H-J, et al. International consensus statement on robotic hepatectomy surgery in 2018. World J Gastroenterol 2019;25:1432–44.

    PubMed  PubMed Central  Google Scholar 

  7. 7.

    Shiraiwa DK, Carvalho PFDC, Maeda CT, et al. The role of minimally invasive hepatectomy for hilar and intrahepatic cholangiocarcinoma: A systematic review of the literature. J Surg Oncol 2020;121:863–72.

    PubMed  Google Scholar 

  8. 8.

    Giulianotti PC, Sbrana F, Bianco FM, Addeo P. Robot-assisted laparoscopic extended right hepatectomy with biliary reconstruction. J Laparoendosc Adv Surg Technol A 2010;20:159–63.

    Google Scholar 

  9. 9.

    Machado MA, Makdissi FF, Surjan RC, Mochizuki M. Laparoscopic resection of hilar cholangiocarcinoma. J Laparoendosc Adv Surg Technol A. 2012;22:954–56.

    Google Scholar 

  10. 10.

    Machado MA, Makdissi FF, Surjan RC. Totally laparoscopic right hepatectomy with Roux-en-Y hepaticojejunostomy for right-sided intraductal papillary mucinous neoplasm of the bile duct. Ann Surg Oncol. 2014;21:1841–43.

    PubMed  Google Scholar 

  11. 11.

    Hu HJ, Wu ZR, Jin YW, et al. Minimally invasive surgery for hilar cholangiocarcinoma: state of art and future perspectives. ANZ J Surg 2019;89:476–80.

    PubMed  Google Scholar 

  12. 12.

    Xu Y, Wang H, Ji W, et al. Robotic radical resection for hilar cholangiocarcinoma: perioperative and long-term outcomes of an initial series. Surg Endosc 2016;30:3060–70.

    PubMed  Google Scholar 

  13. 13.

    Liu QD, Chen JZ, Xu XY, et al. Incidence of port-site metastasis after undergoing robotic surgery for biliary malignancies. World J Gastroenterol 2012;18:5695–5701.

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Gumbs AA, Jarufe N, Gayet B. Minimally invasive approaches to extrapancreatic cholangiocarcinoma. Surg Endosc 2013;27:406–14.

    PubMed  Google Scholar 

  15. 15.

    Li J, Tan X, Zhang X, et al. Robotic radical surgery for hilar cholangiocarcinoma: A single-centre case series. Int J Med Robot 2020;10:e2076.

    Article  Google Scholar 

  16. 16.

    Machado MA, Surjan RC, Basseres T, Makdissi F. Robotic repeat right hepatectomy for recurrent colorectal liver metastasis. Ann Surg Oncol. 2019;26:292–95.

    PubMed  Google Scholar 

  17. 17.

    Machado MA, Surjan RC, Ardengh AO, Makdissi F. Robotic left hepatectomy and Roux-en-Y hepaticojejunostomy after bile duct injury. Ann Surg Oncol. 2019;26:2981–84.

    PubMed  Google Scholar 

  18. 18.

    Machado MAC, Surjan RC, Makdissi F. Robotic ALPPS. Ann Surg Oncol. 2020;27:1174–79.

    PubMed  Google Scholar 

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Correspondence to Marcel Autran Machado MD, FACS.

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Machado, M.A., Mattos, B.V., Lobo Filho, M.M. et al. Robotic Resection of Hilar Cholangiocarcinoma. Ann Surg Oncol 27, 4166–4170 (2020).

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