AI Article Synopsis
- Perihilar cholangiocarcinoma (pCCA) poses significant challenges for liver surgeons, necessitating extended hepatectomy to include segment 1 and the biliary tract; minimally invasive techniques like robotic and laparoscopic surgeries are increasingly being utilized to address this.
- A 79-year-old man with type IIIa pCCA underwent a complex surgical procedure involving extended hepatectomy after careful preoperative preparations, showcasing the need for precise identification of the surgical plane.
- The use of techniques such as dorsal and caudal approaches to the middle hepatic vein, along with an extraglissonian approach, allowed for successful oncological resection while utilizing minimally invasive surgery.
Article Abstract
Background: Perihilar cholangiocarcinoma (pCCA) is one of the most challenging tumours for hepatic surgeons. To reach radical resection, it is mandatory to extend the hepatectomy to segment 1 and biliary tract. With the advent of minimally invasive techniques, an increasing number of centres have begun to treat this tumour using robotic or laparoscopic approaches, demonstrating the ability to maintain oncological standards as well as morbidity and mortality criteria.
Patients And Methods: This video presents a case of a 79-year-old man with pCCA Bismuth type IIIa, undergoing right hepatectomy extended to segment 1 and biliary tract after preoperative optimization including biliary drainage and portal vein and right hepatic vein embolization. Unlike conventional right hepatectomy, extending transection to include segment 1 requires identifying the plane defined by the Arantius duct.
Results: To reach this plane, we suggest using three approaches, previously described in other hepatectomies, were employed: dorsal and caudal approaches to the middle hepatic vein (MHV) and an extraglissonian intrahepatic approach to the left portal pedicle.
Conclusion: With this method, we achieved oncologically radical resection of pCCA using minimally invasive surgical techniques.
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| http://dx.doi.org/10.1245/s10434-024-16279-5 | DOI Listing |
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