ASO Author Reflections: Toward Standardization of Minimally Invasive Surgery Technique for Biliary Tract Cancers: Robotic Left Hemihepatectomy and Portal Lymphadenectomy for Intrahepatic Cholangiocarcinoma

Excerpt

Cholangiocarcinoma is an aggressive malignancy originating from epithelial cells of the biliary tract and is the second most common primary liver cancer. Intrahepatic cholangiocarcinoma (iCCA) is located in the proximal branches of bile ducts and represents <10% of all cholangiocarcinomas with aggressive behavior and generally poor prognosis.¹ iCCA accounts for 3% of gastrointestinal malignancies often associated with late diagnosis.^1‐3 The only potential curative option is complete radical resection of the tumor to achieve long-term survival. With recent advancements in surgical technology, the minimally invasive approaches have been gaining acceptance among hepatobiliary surgeons, promising lower estimated blood loss, shorter postoperative hospital stays, and decreased postoperative complications in comparison with those of a traditional open operation. Despite these promising outcomes as well as the improved ergonomic platform of the robotic device, detailed technical reports on minimally invasive cholangiocarcinoma resection requiring portal lymphadenectomy are sparse as it still remains a challenge for even experienced surgeons. These operations often require major liver resections, formal hilar lymphadenectomy, difficult biliovascular dissection, and complex vascular repairs in cases of tumor invasion and/or unexpected bleeding, hence the sparseness of published literature on the use of laparoscopic and robotic approaches to this disease.^4,5 The majority of hepatobiliary surgeons worldwide still opt for a traditional open approach due to the concerns mentioned above. The most recent advancements in robotic technology offer higher technical versatility over laparoscopic methods, enabling safe and feasible performance of liver resection with high complexity, including total anatomical left hepatectomy with en bloc caudate resection for iCCA.⁵ …