A Case Report and Surgical Video Presentation of Totally Laparoscopic Right Trisectionectomy: Addressing the Challenges of Hepatolithiasis.

Hepatolithiasis, the presence of calculi within the intrahepatic bile ducts, is a rare but challenging condition that can lead to complications such as cholangitis and liver dysfunction. We present the case of a 65-year-old male patient who presented with a history of abdominal pain and chills without clinical jaundice or fever. Laboratory tests revealed mild abnormalities in liver function tests with a cholestatic pattern. Magnetic resonance cholangiopancreatography (MRCP) revealed cholelithiasis, choledocholithiasis, and hepatolithiasis in segments V and VIII. He was started on antibiotic therapy with ciprofloxacin, and an ERCP and cholangioscopy were performed for the extraction of the choledocholithiasis. During the procedure, a stenosis of the right hepatic duct was found and biopsied. In addition, papillotomy was performed with the extraction of multiple stones and biliary sludge, and a 10 Fr plastic stent was placed in the right duct. The biopsy result revealed inflammatory tissue, with neoplasia not completely excluded. An elective laparoscopic right hepatectomy was scheduled. During surgery, ultrasound and cholangiography revealed the presence of hepatolithiasis in segment 4, prompting the decision to change the surgical technique to an extended right hepatectomy, which was performed entirely laparoscopically without incidents. Histopathological analysis of the biliary margin confirmed the absence of malignancy. Totally laparoscopic extended right hepatectomy is a feasible and effective treatment for hepatolithiasis, providing good outcomes with minimal morbidity. This case underscores the importance of surgical intervention in managing complex hepatobiliary disorders.