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2024 ; 16
(7
): 2167-2174
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"Hepatic hilum area priority, liver posterior first": An optimized strategy in
laparoscopic resection for type III-IV hilar cholangiocarcinoma
#MMPMID39087123
Hu XS
; Wang Y
; Pan HT
; Zhu C
; Chen SL
; Zhou S
; Liu HC
; Pang Q
; Jin H
World J Gastrointest Surg
2024[Jul]; 16
(7
): 2167-2174
PMID39087123
show ga
BACKGROUND: In recent years, pure laparoscopic radical surgery for
Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA) has been
preliminarily explored and applied, but the surgical strategy and safety are
still worthy of further improvement and attention. AIM: To summarize and share
the application experience of the emerging strategy of "hepatic hilum area
dissection priority, liver posterior separation first" in pure laparoscopic
radical resection for patients with HCCA of Bismuth-Corlette types III and IV.
METHODS: The clinical data and surgical videos of 6 patients with HCCA of
Bismuth-Corlette types III and IV who underwent pure laparoscopic radical
resection in our department from December 2021 to December 2023 were
retrospectively analyzed. RESULTS: Among the 6 patients, 4 were males and 2 were
females. The average age was 62.2 ± 11.0 years, and the median body mass index
was 20.7 (19.2-24.1) kg/m(2). The preoperative median total bilirubin was 57.7
(16.0-155.7) ?mol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had
Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All
patients successfully underwent pure laparoscopic radical resection following the
strategy of "hepatic hilum area dissection priority, liver posterior separation
first". The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood
loss volume was 195.0 ± 108.4 mL. None of the patients received blood
transfusions during the perioperative period. The median length of stay was 8.3
(7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were
discharged without serious surgery-related complications. CONCLUSION: The
emerging strategy of "hepatic hilum area dissection priority, liver posterior
separation first" is safe and feasible in pure laparoscopic radical surgery for
patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful
for promoting the modularization and process of pure laparoscopic radical surgery
for complicated HCCA, shortens the learning curve, and is worthy of further
clinical application.