Robotic portal lymphadenectomy for biliary tract cancers

The role of minimally invasive surgery (MIS) in the management of biliary tract cancers(BTCs) has long been a topic of debate. One of the primary concerns limiting the adoption of MIS for BTCs is the technical challenge of performing an adequate lymphadenectomy, which is essential for achieving oncologically sound resections. The robotic approach may overcomes some limitations of conventional laparoscopy,potentially expanding the indications for MIS in this setting. We retrospectively analyzed the clinicopathological, intraoperative, and postoperative outcomes of patients who underwent robotic liver resection with concomitant portal lymphadenectomy for BTCs between January 2018 and December 2024. A step-by step description (with video) of our standardized robotic portal lymph node dissection technique is also provided. Among 36 patients who underwent robotic liver resections for BTCs during the studyperiod 32 underwent an associated robotic portal lymphadenectomy. Mean operativetime was 205.67 minutes (range 90-390). Mean blood loss was 180.81 cc (range 30-600). Two patients developed postoperative complication Clavien Dindo > III that requirred a re-intervention. Mean lymph nodes yield was 13 (range 7-21), and all patients had more than 6 retrieved lymph nodes. Final pathology revealed nodal metastases in 11 patients (34.4%). Robotic portal lymphadenectomy for BTCs is a feasibile, and safe technique which can be technically standardized. The robotic approach for the treatment of selected BTCs can guarantees oncological adequacy both in terms of radical R0 liver resection and harvested nodes which was accomplished in all cases.