Approaches in treating infiltrative common bile duct cancer: the potential of robotic hepatopancreatoduodenectomy.

Abstract

Hepatopancreatoduodenectomy (HPD) is a definitive, yet highly complex surgical approach for treating extensive cholangiocarcinoma, characterized by substantial morbidity and mortality. Recent advancements in minimally invasive surgery, particularly robotic platforms, have demonstrated potential in overcoming the technical challenges associated with HPD. Here, we present a case of a 69-year-old male with hilar cholangiocarcinoma extending to the mid and distal common bile duct, successfully managed with robotic left hepatectomy, caudate lobectomy, and pancreaticoduodenectomy (HPD). The operation, performed using the da Vinci Xi system (Intuitive Surgical), lasted 543 minutes with an estimated blood loss of 500 mL. Postoperative complications, including a hepaticojejunostomy leakage, were managed conservatively, and the patient was discharged. This case highlights the feasibility and safety of robotic HPD for complex biliary malignancies, emphasizing its potential as a minimally invasive alternative in select patients when performed by experienced surgeons.