Robotic Partial Hepatectomy Combined with Pancreaticoduodenectomy for Simultaneous Gallbladder and Common Bile Duct...

Hepatopancreatoduodenectomy remains a technically demanding surgical procedure.^1-6 Major hepatectomy combined with pancreaticoduodenectomy is associated with a severe complication rate of 80%, and mortality rate of 10%.^7,8 Minor hepatectomy combined with pancreaticoduodenectomy has been shown to be safe and feasible,⁹ but a robotic surgery approach for such a combination is rarely reported in literature. Here, we present a case of robotic partial hepatectomy combined with pancreaticoduodenectomy for treating simultaneous gallbladder and common bile duct tumors.

A 62-year-old female patient was admitted to our hospital for tumors found in the gallbladder and the distal common bile duct. She had a history of acute pancreatitis 1 month prior. MRCP, enhanced CT, and PET-CT all showed a mass at the fundus of the gallbladder and a nodular lesion in the distal common bile duct, both of which were considered malignant. No other metastatic lesions were found. A robotic procedure was performed using the Da Vinci Xi Surgical Systems.

Peri-pancreatic inflammation and saponification spots were observed during the operation, and fat necrosis with inflammatory cell infiltration was identified by frozen section pathology. The operation time was 408 min, and the estimated blood loss was 300 mL. Grade A pancreatic fistula developed, and the patient was discharged 11 days after surgery. Pathological examination showed well-differentiated adenocarcinoma of the gallbladder and common bile duct, with negative resection margins and no lymph node metastasis.

In an experienced high-volume center, robotic partial hepatectomy combined with pancreaticoduodenectomy is a safe and feasible approach for selected patients.