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

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.