Robotic-Modified Taj Mahal Hepatectomy for Type IV Hilar Cholangiocarcinoma

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Type IV hilar cholangiocarcinoma resection often requires extensive liver resection (trisectionectomy), leading to high morbidity.
• The traditional Taj Mahal hepatectomy involves resection of segments IVb, V, and the caudate lobe.
• A modified approach focusing on segment IV and caudate lobe resection preserves more parenchyma.

Purpose of the Study:

• To describe the standardized technique of robotic-modified Taj Mahal hepatectomy for type IV hilar cholangiocarcinoma.
• To report the initial outcomes of this minimally invasive approach.

Main Methods:

• The procedure involves hepatoduodenal lymphadenectomy, bile duct division, caudate lobe mobilization, and segment IV resection with en bloc caudate lobectomy.
• Indocyanine green (ICG) is used for guidance during segment IV resection.
• Robotic platform facilitates precise dissection and reconstruction.

Main Results:

• The study included four patients over 12 months, with one detailed case presented.
• The described case had an operative time of 560 minutes and 300 mL blood loss.
• The patient achieved negative margins, recovered uneventfully, and remained disease-free at 11-month follow-up.

Conclusions:

• Robotic-modified Taj Mahal hepatectomy is a safe and feasible parenchyma-preserving option.
• This approach is suitable for selected patients with type IV hilar cholangiocarcinoma.
• Further studies are warranted to evaluate long-term outcomes.