Laparoscopic Radical Resection for Hilar Cholangiocarcinoma with Portal Vein Invasions.

Laparoscopic radical resection for hilar cholangiocarcinoma with vascular invasion is technically demanding but feasible in selected cases when performed by an experienced hepatobiliary surgical team. Precise minimally invasive technical execution and systematic surgical workflow organization are critical for mitigating surgical risks. We present a patient with Bismuth type IV HCCA with portal vein invasion who underwent a fully laparoscopic radical resection. The key surgical steps were as follows: (1) "en bloc" resection of hilar lymph nodes and the perihilar neural plexus; (2) segmental resection of the invaded portal vein followed by continuous suture reconstruction; and (3) microsurgical plasty of multiple bile duct orifices in conjunction with Roux-en-Y hepaticojejunostomy. The surgery was completed in 6 h, with an estimated blood loss of 200 mL and without conversion to open laparotomy. Postoperative pathological examination confirmed R0 resection with no lymph node metastases. No postoperative complications, including biliary leakage, haemorrhage, or infection, occurred. The patient remains under surveillance. Follow-up occurred at 1 month and 3 months after surgery, and subsequently occurs every 3 months. Assessments include liver function tests, tumour marker assays, and imaging (ultrasound, CT, or MRI).