Related Experiment Video
Updated: May 1, 2026
Robotic Taj Mahal Hepatectomy for Hilar Cholangiocarcinoma
Published on: July 14, 2022
Robotic-assisted surgery approach in a biliary rhabdomyosarcoma misdiagnosed as choledochal cyst
Ghassan Nakib1, Valeria Calcaterra2, Ilaria Goruppi1
1Department of the Mother and Child Health, Pediatric Surgery Unit, IRCCS Policlinico San Matteo Foundation and University of Pavia , Turin, Italy.
Insights
Hepatobiliary rhabdomyosarcoma can mimic choledochal cysts in children. Robotic surgery offers a safe and effective option for complete tumor resection at the porta hepatis.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Gastroenterology
Background:
- Rhabdomyosarcoma is a rare pediatric soft tissue malignancy.
- Hepatobiliary rhabdomyosarcoma diagnosis can be challenging, often confused with choledochal cysts.
- Early diagnosis and complete resection are crucial for favorable outcomes.
Observation:
- A 2-year-old girl presented with a rare, grapelike lesion involving the choledochal and biliary ducts.
- Preoperative imaging suggested a choledochal cyst, complicating the diagnosis.
- The lesion was successfully resected using robotic-assisted surgery.
Findings:
- Histologic examination confirmed botryoid embryonal rhabdomyosarcoma involving the common bile duct and common hepatic duct.
- The robotic approach facilitated complete tumor excision at the porta hepatis.
- The child remained tumor-free one year post-surgery, with porto-enterostomy performed open due to lack of oncologic safety data for robotic approach.
Implications:
- Robotic-assisted surgery may be a safe and advantageous approach for radical excision of hepatobiliary rhabdomyosarcoma.
- This case highlights the importance of considering malignant lesions in the differential diagnosis of choledochal cysts.
- Further research on the oncologic safety of robotic approaches in pediatric hepatobiliary surgery is warranted.
Abstract:
Rhabdomyosarcoma is a soft tissue malignant tumor affecting 1% of children from 0 to 14 years. Preoperative imaging may not always be diagnostic for hepatobiliary rhabdomyosarcoma and differential diagnosis with choledochal cyst (CC) could be difficult. We report a case of 2-years-old girl with a strange CC pattern of presentation. A grapelike lesion involving the choledochal and biliary ducts was easily and completely resected by robotic assisted surgery. Since no previous reports were available about oncologic safety of robotic approach, the porto-enterostomy was performed in open surgery. On histologic examination, the specimen revealed a botryoidembryonal rhabdomyosarcoma affecting both the common bile duct and the common hepatic duct. One year postoperatively the child is safe of tumor relapse. Robotic approach seems to be safe and advantageous to obtain a radical excision of the tumor at the porta hepatis, even in case of misdiagnosed malignant lesion mimicking a CC.
