Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb

摘要

Perihilar cholangiocarcinoma (pCCA) is a highly malignant and aggressive tumor, with radical resection being the only curative treatment available. With continuous advancements in laparoscopic techniques and instruments, laparoscopic radical surgery for pCCA is now considered technically safe and feasible. However, due to the high complexity of the surgery and the lack of evidence-based clinical support, laparoscopic radical surgery for type IIIb pCCA is performed only in a few large hepatobiliary centers. Current guidelines recommend left hemihepatectomy combined with total caudate lobectomy and standardized lymphadenectomy for resectable type IIIb pCCA. Therefore, in this article, we provide a detailed description of the surgical steps and technical points of complete laparoscopic left hemihepatectomy combined with total caudate lobectomy, regional lymphadenectomy, and right hepatic duct-jejunal Roux-en-Y anastomosis in patients with type IIIb pCCA, using fluorescence navigation technology to enhance surgical precision and safety. By adhering to standardized surgical procedures and precise intraoperative techniques, we offer an effective means to improve patient outcomes.

摘要

Perihilar cholangiocarcinoma (pCCA) is a highly malignant and aggressive tumor, with radical resection being the only curative treatment available. With continuous advancements in laparoscopic techniques and instruments, laparoscopic radical surgery for pCCA is now considered technically safe and feasible. However, due to the high complexity of the surgery and the lack of evidence-based clinical support, laparoscopic radical surgery for type IIIb pCCA is performed only in a few large hepatobiliary centers. Current guidelines recommend left hemihepatectomy combined with total caudate lobectomy and standardized lymphadenectomy for resectable type IIIb pCCA. Therefore, in this article, we provide a detailed description of the surgical steps and technical points of complete laparoscopic left hemihepatectomy combined with total caudate lobectomy, regional lymphadenectomy, and right hepatic duct-jejunal Roux-en-Y anastomosis in patients with type IIIb pCCA, using fluorescence navigation technology to enhance surgical precision and safety. By adhering to standardized surgical procedures and precise intraoperative techniques, we offer an effective means to improve patient outcomes.

引言

Perihilar cholangiocarcinoma (pCCA), also known as Klatskin tumor, was first described by Gerald Klatskin and is a malignant tumor that occurs in the bile duct epithelium at the confluence of the right and left hepatic ducts¹. This disease is highly malignant and aggressive, often presenting with jaundice and cholangitis in advanced stages. Despite advancements in diagnosis and treatment, the prognosis for pCCA remains poor, with radical surgical resection still being the only potentially curative approach. Such surgeries typically involve extensive hepatectomy, bile duct resection, and regional lymphadenectomy². The goa....

研究方案

The study follows the human research ethics committee of the Second Affiliated Hospital of Nanchang University. Written informed consent was obtained from the patient prior to surgery.

NOTE: The patient was a 65-year-old male presenting with a chief complaint of "generalized jaundice and pruritus for 2 weeks". A computed tomography (CT) scan at an outside hospital revealed a perihilar bile duct mass with intrahepatic bile duct dilation. The surgical instruments and equipment used are listed in the Table of Materials.

1. Preoperative preparation

1. Perform routine....

结果

The surgery progressed smoothly, and intraoperative frozen section pathology showed negative margins at both the distal and proximal bile ducts. Throughout the procedure, the patient's vital signs remained stable, and anesthesia was effective. The operation lasted 360 min, with PV occlusion time totaling 60 min (15 min + 5 min × 4 times). Intraoperative blood loss was 400 mL, and the patient received 2 units of leukocyte privative red blood cells and 600 mL of fresh frozen plasma. Postoperative flatus was observ.......

讨论

pCCA is a common malignant tumor of the bile ducts, with radical surgical resection being the only potential curative treatment². Traditional radical surgery for pCCA typically requires an abdominal incision of 20–30 cm, resulting in significant surgical trauma. Large incisions often cause considerable postoperative pain, affecting patient comfort and recovery, thereby prolonging hospital stays^5,6,7.......

材料

Name	Company	Catalog Number	Comments
5-mm trocar	CANWELL MEDICAL Co., LTD	179094F	Sterile, ethylene oxide sterilized, disposable
12-mm trocar	CANWELL MEDICAL Co., LTD	NB12STF	Sterile, ethylene oxide sterilized, disposable
Absorbable Sutures	America Ethicon Medical Technology Co., LTD	W8557/W9109H/VCPB839D	Sterile, ethylene oxide sterilized, disposable
Alligaclip Absorbable Ligating Clip	Hangzhou Sunstone Technology Co., Ltd.	K12	Sterile, ethylene oxide sterilized, disposable
Endoscopic linear cutting stapler	America Ethicon Medical Technology Co., LTD	ECR60W/PSEE60A	Sterile, ethylene oxide sterilized, disposable
Non-absorbable polymer ligature clip	Greiner Bio-One Shanghai Co., Ltd.	0301-03M04/0301-03L04/0301-03ML02	Sterile, ethylene oxide sterilized, disposable
NonAbsorbable Sutures	America Ethicon Medical Technology Co., LTD	EH7241H/EH7242H	Sterile, ethylene oxide sterilized, disposable
Ultrasonic scalpel	America Ethicon Medical Technology Co., LTD	HARH36	Sterile, ethylene oxide sterilized, disposable