Robotic surgery twice performed in the treatment of hilar cholangiocarcinoma with deep jaundice: delayed right hemihepatectomy following the right-hepatic vascular control.
OBJECTIVE
To explore and find a new method to treat hilar cholangiocarcinoma with deep jaundice assisted by Da Vinci robot.


METHODS
A hilar cholangiocarcinoma patient of type Bismuch-Corlette IIIa was found with deep jaundice (total bilirubin: 635 µmol/L). On the first admission, we performed Da Vinci robotic surgery including drainage of left hepatic duct, dissection of right hepatic vessels (right portal vein and right hepatic artery), and placement of right-hepatic vascular control device. Three weeks later on the second admission when the jaundice disappeared we occluded right-hepatic vascular discontinuously for 6 days and then sustained later. On the third admission after 3 weeks of right-hepatic vascular control, the right hemihepatectomy was performed by Da Vinci robot for the second time.


RESULTS
The future liver remnant after the right-hepatic vascular control increased from 35% to 47%. The volume of left lobe increased by 368 mL. When the total bilirubin and liver function were all normal, right hemihepatectomy was performed by Da Vinci robot 10 weeks after the first operation. The removal of atrophic right hepatic lobe with tumor in bile duct was found with no pathologic cancer remaining in the margin. The patient was followed up at our outpatient clinic every 3 months and no tumor recurrence occurs by now (1 y).


CONCLUSIONS
Under the Da Vinci robotic surgical system, a programmed treatment can be achieved: first, the hepatic vessels were controlled gradually together with biliary drainage, which results in liver's partial atrophy and compensatory hypertrophy in the other part. Then a radical hepatectomy could be achieved. Such programmed hepatectomy provides a new treatment for patients of hilar cholangiocarcinoma with deep jaundice who have the possibility of radical heptolobectomy.
*Department of Hepatobiliary Surgery, PLA NO. 302 Hospital †Institute of Hepatobiliary Gastrointestinal Disease, General Hospital of PLA SA, Beijing ‡Department of Occupational and Environmental Health, School of Public Health, Fourth Military Medical University, Xi'an, China.
Zhenyu
Z
Zhu
Quanda
Q
Liu
Junzhou
J
Chen
Weihong
W
Duan
Maosheng
M
Dong
Peiyuan
P
Mu
Di
D
Cheng
Honglei
H
Che
Tao
T
Zhang
Xiaoya
X
Xu
Ningxin
N
Zhou
D000328:Adult; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007565:Jaundice / Q000150:complications*; D008099:Liver / Q000098:blood supply*; D008297:Male; D012086:Reoperation; D065287:Robotic Surgical Procedures