290 Robotic Left Hemihepatectomy for a Perihilar Cholangiocarcinoma in Situ Arising from an Intraductal Papillary Neoplasm of the Left Hepatic Duct

Abstract Aim A 65-year-old male with no other comorbidities presented to a local district general hospital with upper abdominal pain and weight loss. Imaging (CT and MRI) showed a 4.6 cm multiloculated cystic lesion centrally in Segment 4a arising from the left hepatic duct concerning for an intraductal papillary neoplasm of the bile duct (IPNB). CEA was <2. MDT review recommended resection based on size criteria. Method At surgery, the cystic lesion was noted to be arising from the left hepatic duct close, but not involving, the confluence. The patient underwent a robotic left hemihepatectomy with cholecystectomy without the need for bile duct excision and hepaticojejunostomy. Results Postoperative histology showed an IPNB with high grade dysplasia and intraductal mucinous adenocarcinoma with clear resection margins (Tis, N0; R0). He was discharged on postoperative day 5 with a small bile leak which was managed on an ambulatory nurse-led clinic basis and the drain was removed on Day 10 (ISGLS Grade B). Conclusions A video of a robotic left hemihepatectomy for a perihilar cholangiocarcinoma in situ arising from an intraductal papillary neoplasm of the left hepatic duct is presented. This case shows that robotic surgery is safe and feasible for cystic neoplasms at the hilum without the need for bile duct excision and reconstruction in select cases.