Robotic Resection of Right Perihilar Intrahepatic Cholangiocarcinoma: Practical Technique of Major Hepatic Resection for Biliary Tract Cancer.

Authors

Shivanshu Kumar, Maria Christodoulou, Iswanto Sucandy

Published in

The American surgeon. Pages 31348261465401. Jun 27, 2026. Epub Jun 27, 2026.

Abstract

Intrahepatic juxtahilar cholangiocarcinoma frequently necessitates major hepatic resection with radical regional lymphadenectomy to achieve oncologic clearance and accurate staging; however, standardized easy-to-follow robotic techniques for centrally located tumors remain limited. Herein, we present a fully robotic right hepatectomy with formal portal lymphadenectomy in a 76-year-old woman with a 5.5-cm centrally located intrahepatic cholangiocarcinoma with underlying hepatic steatosis. Preoperative evaluation included cross-sectional imaging and volumetric assessment to ensure adequate future liver remnant, consistent with contemporary recommendations for minimally invasive major hepatectomy. The procedure was performed using a structured, stepwise approach emphasizing early hilar dissection, inflow-first control, parenchymal transection under low central venous pressure <5mmHg, and systematic portal lymphadenectomy. The operation was completed in 6 hours with an estimated blood loss of 150 mL without Pringle maneuver. The patient was discharged on postoperative day 5 without perioperative complications. Final pathology demonstrated a poorly differentiated intrahepatic cholangiocarcinoma with negative margins (R0) and no lymph node metastases (0/6), consistent with current staging recommendations. At one year, the patient remains disease free. Beyond technical feasibility, this report illustrates a reproducible operative framework informed by cumulative institutional experience, including prior analyses of robotic hepatectomy outcomes, learning-curve progression, and preoperative difficulty stratification. This approach may support incremental expansion of robotic indications for selected centrally located tumors within established hepatobiliary programs.

PMID:
42363663
Bibliographic data and abstract were imported from PubMed on 27 Jun 2026.

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