Laparoscopic extended right hepatectomy, portal lymphadenectomy, and hepaticojejunostomy for hilar cholangiocarcinoma.
BACKGROUND
Laparoscopic-assisted extended hepatectomy and laparoscopic hepaticojejunostomy reconstruction can be performed for hilar cholangiocarcinoma by combining our existing protocols for laparoscopic anatomic hepatectomy and laparoscopic hand-sewn bilio-enteric anastomosis.


METHODS
Our first patient was a 42-year-old man with cholangitis and jaundice from tumor obstructing the hepatic duct bifurcation who underwent a right extended hepatectomy for hilar cholangiocarcinoma (Bismuth IIIa), radical portal lymphadenectomy, and Roux-en-Y hepaticojejunostomy using laparoscopic techniques. A four-trocar, one 6-cm wound protector laparoscopic technique was used. Inflow and outflow exclusion was achieved first, followed by liver transection. Radical portal lymphadenectomy was performed. A Roux-en-Y hepaticojejunostomy was constructed laparoscopically. We have performed three other cases using the same technique: two requiring right extended hepatectomy and one requiring left extended hepatectomy.


RESULTS
No intraoperative complications occurred during the 4.0-hour procedure. Tumor margins were clear. The patient was given oral diet on Day 1 and discharged on Day 3 after surgery. No blood transfusions were necessary. A cholangiogram performed 10 days after surgery demonstrated patent hepaticojejunostomy, and magnetic resonance imaging performed during week 3 demonstrated the normal caliber of the intrahepatic biliary system. At 6 months, the patient was completely without symptoms and exhibited normal liver function tests.


CONCLUSIONS
Laparoscopic-assisted right extended hepatectomy for hilar cholangiocarcinoma with laparoscopically hand-sewn hepaticojejunostomy in select patients can be achieved with good outcomes.
Hepatobiliary Pancreas Program, Division of Gastrointestinal & General Surgery, Department of Surgery, Emory University School of Medicine , Atlanta, Georgia .
Edward
E
Lin
Juan M
JM
Sarmiento
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D001650:Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D018281:Cholangiocarcinoma / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008099:Liver / Q000601:surgery*; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male