Laparoscopic Resection of Perihilar Cholangiocarcinoma Type IIIb: A Video Demonstration of No-Touch En-Block Technique and Radical Lymphadenectomy.

Abstract

BACKGROUND: Minimally invasive surgery for perihilar cholangiocarcinoma (pCCA) is in an exploratory phase by now and is only recommended for carefully selected patients. PATIENTS AND METHODS: Our team performed total laparoscopic hepatectomy in a 64-year-old woman with perihilar cholangiocarcinoma type IIIb. Laparoscopic left hepatectomy and caudate lobectomy were performed involving a no-touch en-block technique. Meanwhile, extrahepatic bile duct resection, radical lymphadenectomy with skeletonization, and biliary reconstruction were performed. RESULTS: Laparoscopic left hepatectomy and caudate lobectomy were successfully performed in 320 min with 100 ml of blood loss. The histological grading was T2bN0M0 (stage II). The patient was discharged on the 5th day without postoperative complications. Following the operation, the patient received single-drug capecitabine chemotherapy. There was no recurrence after 16 months of follow-up. CONCLUSION: Our experience is that, in selected patients with pCCA type IIIb or type IIIa, laparoscopic resection can reach comparable outcome to open surgery with standardized lymph node dissection by skeletonization, use of no-touch en-block technique, and proper digestive tract reconstruction.