Real robotic approach for left hepatectomy with en bloc caudatectomy and portal vein resection for Bismuth IIIb hilar cholangiocarcinoma.

This article provides a detailed description of the robotic approach used to perform an extended left hepatectomy with venous resection in a 65-year-old female patient with a Bismuth-Corlette tumour type 3b infiltrating the portal confluence. A Glissonean pedicle approach was used to achieve total prehepatic vascular control and resection of the left portal confluence, followed by transverse reconstruction according to the Heineke-Mikulicz technique. The parenchymal transection, including the entire caudate lobe, was performed robotically, with left hanging manoeuvre after complete piggybacking of the vena cava. The final pathological result was G3 pT2bN1M0 (2/11) signet ring cell adenocarcinoma. The robotic approach enabled adjuvant treatment to be initiated immediately. No major complications were recorded within 90 days, and the patient was discharged on the 5th day.