Robotic anatomical left hepatectomy with enbloc caudate resection for intrahepatic cholangiocarcinoma

<h2>Abstract</h2><h3>Introduction</h3> Minimally invasive robotic technique is gaining popularity due to its technical advantages when compared with conventional laparoscopy. Major hepatic lobectomy, however, remains a technically demanding procedure and requires extensive training to ensure safety and efficacy, especially when undertaken using minimally invasive approach.^1–4 With focus on robotic surgery techniques, in this video we describe our standardized technical approach of robotic anatomical left hepatectomy with enbloc caudate lobe resection. <h3>Methods</h3> A 78-year-old man presented with a caudate lobe cholangiocarcinoma infiltrating the caudate lobe and dorsal aspect of segment 4 with a very close proximity to the base of umbilical fissure. No evidence of extrahepatic metastasis is seen. Left anatomical hepatic lobectomy enbloc with caudate resection is needed to oncologically remove the tumor, in addition to radical portal abdominal lymphadenectomy. Technical operative steps are shown in the multimedia video. <h3>Results</h3> Total operative time was 270 min, with an estimated blood loss of 100 mL. The patient had an uneventful postoperative recovery and he was discharged on postoperative day 6. Pathologic evaluation revealed a 6.7 cm moderately differentiated cholangiocarcinoma with negative margins. <h3>Conclusion</h3> This case highlights the safety, feasibility, and technical steps of robotic anatomical left hepatic lobectomy with enbloc caudate resection.