da Vinci Robot-Assisted resection for hilar cholangiocarcinoma: preliminary experience from china

Abstract：Objective. To summarize the initial experience of application of da Vinci Surgical System for resection of hilar cholangincarcinoma. Methods Fifty-seven patients undergone robot-assisted hepatobiliopancreatic (HBP) operations from January to June 2009 were reviewed, and the clinical results of the 6 cases receiving resection of hilar cholangiocarcinoma were introduced.Results The Bismuth classification of 6 patients (5 male, 1 female, with average ages of 60±8 years old) with hilar cholangiocarcinoma was: 1 of type I, 2 of type Ⅲb, 3 of type Ⅳ. One patient performed PTC drainage 1-month ago.The robot-assisted surgical procedures included: radical resection of hilar cholangiocarcinoma and Roux-en-Y hepatojejunostomy for 1 patient with Bismuth type I, left hemihepatectomy for 1 patient with Bismuth type Ⅲb, resection of hilar cholangiocarcinoma and external drainage of secondary biliary radicals for 1 patient with Bismuth type Ⅲb, and resection of hilar cholangiocarcinoma and biliary reconstruction with gallbladder bridging for 3 patients with Bismuth type Ⅳ. All patients recovered uneventfully. Incomplete intestinal obstruction was occurred in one patient after overfeeding on fifth postoperative day, which was relieved by one-day fasting. No complications such as biliary leak, peritonitis occurred. No signs of tumor recurrence were revealed during a median 3-month follow-up period.Conclusion Robot-assisted resection for hilar cholangiocarcinoma is feasibility and safe. The robotic surgical system has superiority such as precision, dexterity while performing the operation, and faster recovery for patients, which offers the future trend for HBP minimally invasive surgery. However, further study is mandatory to clarify the longterm results following robot-assisted resection for hilar cholangiocarcinoma.