Robotic Resection of Type 2 Klatskin's Tumor With Portal Vein Lateral Venorrhaphy and Dual Hepaticojejunostomy Biliary Reconstruction.
Allyson Lim-Dy, Maria Christodoulou, Iswanto Sucandy
✦ AI-curated · Sources linked
Case in brief
A 72-year-old man presented with obstructive jaundice and a mid-bile duct stricture; evaluation identified a Bismuth type II perihilar cholangiocarcinoma with localized hilar involvement and no significant extension into either hepatic duct. He underwent robotic extrahepatic bile duct resection, radical lymphadenectomy, and portal vein lateral venorrhaphy without conversion to open surgery. Unification ductoplasty of the right anterior and posterior sectoral ducts allowed dual hepaticojejunostomy reconstruction. Negative proximal and distal margins were achieved without formal hepatectomy. At 2-year surveillance, he had no evidence of recurrence.
What made this case unusual
The operation combined robotic portal vein repair with unification ductoplasty and dual hepaticojejunostomy, while avoiding formal hepatectomy in a selected type II tumor with limited ductal extension.
Diagnostic / clinical pearl
For selected Bismuth type II tumors without substantial extension into the right or left hepatic ducts, bile duct resection may achieve negative margins without formal hepatectomy; careful assessment of ductal extent is central to this approach.
Why it matters
The case illustrates the technical feasibility of robotic vascular repair and complex biliary reconstruction in this selected setting.