Robotic Type 3B Klatskin Tumor Resection: Technique of Unification Ductoplasty for Roux-en-Y Biliary Reconstruction.

BACKGROUND

Application of robotic platform for perihilar cholangiocarcinoma is an emerging technique requiring expertise in both minimally invasive hepatic resection and biliary reconstruction. Due to oncological principles of trying to achieve tumor-free margins during cholangiocarcinoma operation, surgeons often find multiple sectoral bile ducts above the hilar plate that need to be reconstructed. Creating multiple oligomilimeter hepaticojejunostomy anastomoses is not only technically very challenging but also associated with an increased risk for postoperative bile leak and subsequent anastomotic stricture mandating reinterventions.

METHODS

Technical maneuvers to reduce the number of biliary anastomosis had been previously described in open surgical literature. Minimally invasive technique such as simple unification ductoplasty, however, has not been described laparoscopically or robotically.

RESULTS

We demonstrated a successful unification ductoplasty during a robotic type 3B Klatskin tumor resection according to Bismuth-Corlette classification. Creation of multiple anastomoses in this type of operation was able to be avoided.

CONCLUSION

Robotic platform facilitates ductoplasty for biliary reconstruction during Klatskin tumor resection.