Intraoperative Strategy under Complex Vascular Adhesion for Laparoscopic Radical Resection of Bismuth-Corlette Type IIIb Perihilar Cholangiocarcinoma

Perihilar cholangiocarcinoma (pCCA) is a highly challenging malignancy, often requiring extensive hepatic resection to achieve curative treatment. This article presents a case of Bismuth-Corlette type IIIb pCCA in a 53-year-old male patient who underwent a laparoscopic left hemihepatectomy with caudate lobe resection, lymphadenectomy, and Roux-en-Y hepaticojejunostomy. Preoperative percutaneous transhepatic biliary drainage (PTCD) was performed to relieve obstructive jaundice and improve liver function. Intraoperatively, the tumor was found to be densely adherent to the proper hepatic artery (PHA) and right hepatic artery (RHA), necessitating meticulous vascular dissection. An intraoperative arterial injury was successfully repaired using microsurgical suturing under laparoscopic guidance. Complete lymphadenectomy was conducted at stations 1, 3, 7, 8, 9, 12, and 13. The caudate lobe was entirely resected to ensure oncologic radicality. The postoperative course was uneventful, except for a transient bile leak that resolved with conservative management. Final pathology confirmed R0 resection with no lymph node metastasis. This case demonstrates the technical feasibility and safety of advanced laparoscopic approaches in complex pCCA, emphasizing the importance of preoperative planning, vascular control, and multidisciplinary collaboration.