Robotic Resection of Type 2 Klatskin’s Tumor With Portal Vein Lateral Venorrhaphy and Dual Hepaticojejunostomy Biliary Reconstruction

Abstract

Perihilar cholangiocarcinoma (Klatskin tumor) remains one of the most technically challenging hepatopancreatobiliary malignancies because of its close association with the portal vein and hepatic artery within the hepatic hilum. Current operative management of Bismuth type I and II lesions remains controversial, particularly regarding the role of bile duct resection alone versus combined hepatectomy to achieve oncologically adequate R0 margins while minimizing operative morbidity. While traditionally managed through an open approach, robotic surgery has emerged as a minimally invasive option for selected complex biliary and vascular resections. We present the robotic resection of a Bismuth type II Klatskin tumor in a 72-year-old male who presented with obstructive jaundice and a mid-bile duct stricture. Following preoperative optimization, the patient underwent robotic extrahepatic biliary resection, radical lymphadenectomy, portal vein lateral venorrhaphy, and Roux-en-Y biliary reconstruction. Preoperative imaging and intraoperative assessment demonstrated localized hilar involvement without significant longitudinal extension into the right or left hepatic ducts, allowing bile duct resection without formal hepatectomy while still achieving negative proximal and distal margins. Tumor resection was completed without conversion to open surgery. Portal vein cross-clamp time was 10 minutes. Unification ductoplasty between the right anterior and posterior sectoral ducts enabled dual hepaticojejunostomy reconstruction. At 2-year surveillance follow-up, the patient remained without evidence of recurrence. This case demonstrates the technical feasibility of robotic portal vein lateral venorrhaphy and complex biliary reconstruction in selected Bismuth type II perihilar cholangiocarcinoma requiring dual hepaticojejunostomy reconstruction.