Abstract：
BACKGROUND: Robotic technology is increasingly utilized in perihilar cholangiocarcinoma treatments, requiring expertise in minimally invasive liver surgeries and biliary reconstructions. These resections often involve vascular and multiple sectoral bile duct reconstructions. Minimally invasive vascular repairs are now emerging with promising outcomes, potentially altering criteria for selecting minimally invasive hepatobiliary tumor resections. In this multimedia article, we describe our technique of robotic portal venous tangential primary reconstruction with right sectoral bile duct unification ductoplasty for the treatment of perihilar cholangiocarcinoma using the robotic approach.
METHODS: The robotic technique was chosen in this operation with preoperative anticipation of needing vascular resection and reconstruction due to left portal vein tumor involvement. Additionally, a Roux-en-Y hepaticojejunostomy to the right anterior and posterior sectoral duct was planned for biliary reconstruction. Proximal and distal vascular control of the portal vein bifurcation was obtained by placing vascular bulldog clamps across the main and right portal veins. Once an R0 vascular margin was obtained on the left portal vein, portal bifurcation was tangentially repaired. Perfusion to the liver was then restored, and left hemihepatectomy with en bloc extrahepatic biliary resection was carried out, followed by Roux-en-Y hepaticojejunostomy reconstruction to the right anterior and posterior sectoral bile ducts, as a single anastomosis.
RESULTS: The operation was uneventful without vascular or biliary complications. Robotic unification ductoplasty circumvented the need for multiple anastomoses.
CONCLUSIONS: The robotic approach for left-sided perihilar cholangiocarcinoma resections, requiring precise biliovascular management, is safe, feasible, and efficient. This method demonstrates the potential of robotic techniques as an alternative to traditional open surgery.
METHODS: The robotic technique was chosen in this operation with preoperative anticipation of needing vascular resection and reconstruction due to left portal vein tumor involvement. Additionally, a Roux-en-Y hepaticojejunostomy to the right anterior and posterior sectoral duct was planned for biliary reconstruction. Proximal and distal vascular control of the portal vein bifurcation was obtained by placing vascular bulldog clamps across the main and right portal veins. Once an R0 vascular margin was obtained on the left portal vein, portal bifurcation was tangentially repaired. Perfusion to the liver was then restored, and left hemihepatectomy with en bloc extrahepatic biliary resection was carried out, followed by Roux-en-Y hepaticojejunostomy reconstruction to the right anterior and posterior sectoral bile ducts, as a single anastomosis.
RESULTS: The operation was uneventful without vascular or biliary complications. Robotic unification ductoplasty circumvented the need for multiple anastomoses.
CONCLUSIONS: The robotic approach for left-sided perihilar cholangiocarcinoma resections, requiring precise biliovascular management, is safe, feasible, and efficient. This method demonstrates the potential of robotic techniques as an alternative to traditional open surgery.
摘要：
背景：机器人技术越来越多地用于肝门部胆管癌治疗，需要微创肝脏手术和胆道重建的专业知识。这些切除通常涉及血管和多个部门的胆管重建。微创血管修复现在正在出现，并取得了有希望的结果，可能改变选择微创肝胆肿瘤切除术的标准。在这篇多媒体文章中，我们描述了使用机器人方法进行机器人门静脉切向初次重建与右部门胆管统一导管成形术治疗肝门部胆管癌的技术。
方法：本次手术选择机器人技术，术前预期左门静脉肿瘤受累需要血管切除和重建。此外,计划对右前和后部门导管进行Roux-en-Y肝空肠吻合术，以进行胆道重建。通过在主门静脉和右门静脉上放置血管斗牛犬钳，可以获得门静脉分叉的近端和远端血管控制。一旦在左门静脉获得R0血管边缘，门户分叉进行了切线修复。然后恢复了肝脏的灌注，并进行了左半肝切除术和整块肝外胆管切除术，随后Roux-en-Y肝空肠吻合术重建右前和后部门胆管，作为一个单一的吻合。
结果：手术顺利，无血管或胆道并发症。机器人统一导管成形术避免了多次吻合的需要。
结论：左侧肝门周围胆管癌切除的机器人方法，需要精确的胆道管理，是安全的,可行,高效。这种方法证明了机器人技术作为传统开放手术的替代方案的潜力。
方法：本次手术选择机器人技术，术前预期左门静脉肿瘤受累需要血管切除和重建。此外,计划对右前和后部门导管进行Roux-en-Y肝空肠吻合术，以进行胆道重建。通过在主门静脉和右门静脉上放置血管斗牛犬钳，可以获得门静脉分叉的近端和远端血管控制。一旦在左门静脉获得R0血管边缘，门户分叉进行了切线修复。然后恢复了肝脏的灌注，并进行了左半肝切除术和整块肝外胆管切除术，随后Roux-en-Y肝空肠吻合术重建右前和后部门胆管，作为一个单一的吻合。
结果：手术顺利，无血管或胆道并发症。机器人统一导管成形术避免了多次吻合的需要。
结论：左侧肝门周围胆管癌切除的机器人方法，需要精确的胆道管理，是安全的,可行,高效。这种方法证明了机器人技术作为传统开放手术的替代方案的潜力。
