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Abstract：
BACKGROUND: In recent years, pure laparoscopic radical surgery for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA) has been preliminarily explored and applied, but the surgical strategy and safety are still worthy of further improvement and attention.
OBJECTIVE: To summarize and share the application experience of the emerging strategy of \"hepatic hilum area dissection priority, liver posterior separation first\" in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV.
METHODS: The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types III and IV who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.
RESULTS: Among the 6 patients, 4 were males and 2 were females. The average age was 62.2 ± 11.0 years, and the median body mass index was 20.7 (19.2-24.1) kg/m2. The preoperative median total bilirubin was 57.7 (16.0-155.7) μmol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All patients successfully underwent pure laparoscopic radical resection following the strategy of \"hepatic hilum area dissection priority, liver posterior separation first\". The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood loss volume was 195.0 ± 108.4 mL. None of the patients received blood transfusions during the perioperative period. The median length of stay was 8.3 (7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were discharged without serious surgery-related complications.
CONCLUSIONS: The emerging strategy of \"hepatic hilum area dissection priority, liver posterior separation first\" is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA, shortens the learning curve, and is worthy of further clinical application.
OBJECTIVE: To summarize and share the application experience of the emerging strategy of \"hepatic hilum area dissection priority, liver posterior separation first\" in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV.
METHODS: The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types III and IV who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.
RESULTS: Among the 6 patients, 4 were males and 2 were females. The average age was 62.2 ± 11.0 years, and the median body mass index was 20.7 (19.2-24.1) kg/m2. The preoperative median total bilirubin was 57.7 (16.0-155.7) μmol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All patients successfully underwent pure laparoscopic radical resection following the strategy of \"hepatic hilum area dissection priority, liver posterior separation first\". The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood loss volume was 195.0 ± 108.4 mL. None of the patients received blood transfusions during the perioperative period. The median length of stay was 8.3 (7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were discharged without serious surgery-related complications.
CONCLUSIONS: The emerging strategy of \"hepatic hilum area dissection priority, liver posterior separation first\" is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA, shortens the learning curve, and is worthy of further clinical application.
摘要：
背景：近年来，对Bismuth-CorletteⅢ型和Ⅳ型肝门部胆管癌(HCCA)的单纯腹腔镜根治术进行了初步探索和应用,但手术策略和安全性仍值得进一步改进和重视。
目的：总结和分享“肝门区清扫优先”新兴策略的应用经验，在III和IV型铋-CorletteHCCA患者的纯腹腔镜根治性切除术中，首先进行肝后分离。
方法：回顾性分析2021年12月至2023年12月我科收治的6例III型和IV型HCCA患者的临床资料和手术录像。
结果：在6例患者中，4人为男性，2人为女性。平均年龄62.2±11.0岁,中位体重指数为20.7（19.2-24.1）kg/m2。术前中位总胆红素为57.7(16.0-155.7)μmol/L。一名患者患有铋-科莱特IIIa型，4例患者患有铋-科莱特IIIb型，1例患者患有IV型Bismuth-Corlette。所有患者均按照“肝门区解剖优先”的策略成功进行单纯腹腔镜根治术，肝后分离首先\"。手术时间358.3±85.0分钟,术中出血量为195.0±108.4mL。在围手术期，没有患者接受输血。中位住院时间为8.3（7.0-10.0）天。2例患者出现轻度胆漏,所有患者均出院，无严重手术相关并发症。
结论：“肝门区解剖优先”的新兴策略，对于III型和IV型Bismuth-Corlette的HCCA患者，单纯腹腔镜下根治性手术是安全可行的。该策略有助于促进单纯腹腔镜下复杂HCCA根治术的模块化和程序化。缩短了学习曲线，值得临床进一步推广应用。
目的：总结和分享“肝门区清扫优先”新兴策略的应用经验，在III和IV型铋-CorletteHCCA患者的纯腹腔镜根治性切除术中，首先进行肝后分离。
方法：回顾性分析2021年12月至2023年12月我科收治的6例III型和IV型HCCA患者的临床资料和手术录像。
结果：在6例患者中，4人为男性，2人为女性。平均年龄62.2±11.0岁,中位体重指数为20.7（19.2-24.1）kg/m2。术前中位总胆红素为57.7(16.0-155.7)μmol/L。一名患者患有铋-科莱特IIIa型，4例患者患有铋-科莱特IIIb型，1例患者患有IV型Bismuth-Corlette。所有患者均按照“肝门区解剖优先”的策略成功进行单纯腹腔镜根治术，肝后分离首先\"。手术时间358.3±85.0分钟,术中出血量为195.0±108.4mL。在围手术期，没有患者接受输血。中位住院时间为8.3（7.0-10.0）天。2例患者出现轻度胆漏,所有患者均出院，无严重手术相关并发症。
结论：“肝门区解剖优先”的新兴策略，对于III型和IV型Bismuth-Corlette的HCCA患者，单纯腹腔镜下根治性手术是安全可行的。该策略有助于促进单纯腹腔镜下复杂HCCA根治术的模块化和程序化。缩短了学习曲线，值得临床进一步推广应用。
