Robotic Partial Central Hepatectomy with Biliary Resection and R-Y Hepaticojejunostomy for Gallbladder Adenocarcinoma: Technique of Biliary Anastomosis with Hepp-Couinaud Maneuver.

BACKGROUND: The robotic approach for complex hepatobiliary resection transforms challenging minimally invasive procedures to technically feasible, more efficient, and even routine operations in many centers. Gallbladder cancer extirpation with en bloc biliary resection and Roux-en-Y hepaticojejunostomy currently is undergoing technical evolution from traditional open to robotic technique. Complete understanding of hilar dissection and the biliary anastomosis technique, including the Hepp-Couinaud Maneuver, is mandatory to achieving long-term outcomes. Published technical report describing this approach is lacking in modern literature. This report describes our standardized practical technique of robotic partial central hepatectomy with biliary resection and R-Y-hepaticojejunostomy for gallbladder adenocarcinoma.

METHODS: A 62-year-old woman presented with a 5.3-cm gallbladder mass concerning for adenocarcinoma. The patient's CA 19-9 was 956 mg/dL, and her alpha fetoprotein and carcinoembryonic antigen levels were normal. Computed tomography and/MRI imaging showed the absence of regional or extrahepatic disease. A robotic approach was planned after multidisciplinary tumor board discussions.

RESULTS: The total operative time was 240 min, with an estimated blood loss of 150 mL. The patient was discharged on postoperative day 8 without any complications. At 12 months, she had no evidence of tumor recurrence CONCLUSION: This case highlights the safety, feasibility, and reproducibility of a minimally invasive robotic approach for partial central hepatectomy with biliary resection and R-Y hepaticojejunostomy.