Robotic Total Anatomical Left Hepatectomy with En Bloc Caudate Resection and Systematic Portal Lymphadenectomy for Intrahepatic Cholangiocarcinoma.

Introduction: Intrahepatic cholangiocarcinoma is the second most common primary liver cancer with an aggressive behavior and poor prognosis. The only potential curative option is radical resection, traditionally undertaken via an open operation. Reports on minimally invasive approach are sparse and limited. In this video, we described our technique for robotic total anatomical left hepatectomy with en bloc caudate resection for an intrahepatic cholangiocarcinoma involving segment 1 and dorsal aspect of segment. METHODS: A 78-year-old man presented to our office with a caudate lobe mass infiltrating dorsal aspect of left hepatic lobe. CT scan of abdomen/pelvis showed a large caudate lobe mass, consistent with an intrahepatic cholangiocarcinoma. No evidence of extrahepatic metastasis was seen. The operation was undertaken by using a robotic platform with 5 ports. An intraoperative ultrasound was used to mark the location of the middle hepatic vein to be preserved while securing R-0 parenchymal margins.

Results: Operation time was 4.5 hours with 100 cc blood loss. The postoperative course was uneventful, and the patient was discharged home on postoperative day 6. Pathological results showed moderately differentiated cholangiocarcinoma of Caudate lobe (6.7 cm) with two additional satellite lesions in the left hepatic lobe (0.5 cm, 0.7 cm). Background liver tissue showed congested sinusoids and minimal macrovesicular steatosis negative for significant cholestasis, inflammation, or fibrosis. 1/13 hilar lymph nodes was involved by carcinoma.

Conclusions: We demonstrated a safe, feasible, and reproducible technique of robotic total anatomical left hepatectomy with en bloc caudate resection and portal lymphadenectomy for intrahepatic cholangiocarcinoma.