Laparoscopic right extended hepatectomy for perihilar cholangiocarcinoma: surgical technique

The minimally invasive approach for biliary tract cancer tumors, most often requiring major liver resections and formal hilar lymphadenectomy, represents a technical challenge, but several reports in the literature have reported its feasibility and safety. The aim of this study is to provide a step-by-step technical overview of our surgical approach to perihilar cholangiocarcinoma (pCCA). We describe a standardized technique through the case of a 59-year-old man with a Bismuth-Corlette type IIIa pCCA who underwent a minimally invasive right extended hepatectomy associated with hilar lymphadenectomy, resection of the biliary confluence (H15678-B) and a Roux-en-Y hepaticojejunal anastomosis. The operative time was 300 minutes, and the estimated blood loss was 250 mL. The postoperative course was uneventful, with discharge on day 7. Pathological analysis confirmed a pT2aN0R0 cholangiocarcinoma with nine negative lymph nodes, and the patient remained disease-free at 12-month follow-up. While minimally invasive approaches to pCCA remain limited to specialized centers and carefully selected patients, our experience adds to the growing body of literature demonstrating its technical feasibility, oncological adequacy, and favorable short-term outcomes. Further studies and longer follow-up are required to better define patient selection criteria and long-term oncological outcomes. Nevertheless, this case supports the evolving role of laparoscopic surgery as a viable and safe option for the treatment of complex biliary tumors, when performed by experienced hepatobiliary and pancreatic (HPB) surgical teams following a standardized and meticulous operative strategy.