Robotic Biliary Resection & Reconstruction for Biliary/Liver Cancers

Biliary resection with reconstruction is mainly performed to treat biliary duct cancer or stricture (for multiple reasons). The main treatment for biliary duct cancer is complete surgical resection of the involved bile duct to achieve negative margins. The regional lymphnodes are also systematically resected for diagnostic and therapeutic purposes. Biliary resection is a highly complex and specialized operation due to its confined location and presence of surrounding important vessels feeding the liver. Majority of general surgeons in the community are not familiar with biliary resection or biliary reconstruction. The expertise in bile duct resection is centralized to only a few major liver surgery centers or surgical oncology centers, such as our program. Understanding of biliary anatomy is crucial for a safe bile duct resection. Anomaly or aberrant bile duct branches need to be recognized before and during the operation to avoid complications. Gentle handling of the bile duct is also important to avoid devascularization of the bile duct leading to a chronic biliary stricture at later time.

Biliary resection with reconstruction is technically demanding and requires high surgical precision. Majority of this operation is performed via the traditional open operation. In the past several years, minimally invasive surgical technique is applied not only to liver surgery, but also to biliary tract surgery. Laparoscopic biliary resection with reconstruction has been reported in the literature and the outcome data are being prospectively collected. Robotic biliary resection is then introduced to overcome inherent limitations of laparoscopic technique such as difficult tissue dissection, awkward angle of suturing, and often poor visualization. Klatskin tumor (bile duct cancer involving bifurcation of the right and left hepatic duct) is an example, where the robotic biliary resection technique can be truly beneficial. Historically, Klatskin tumor resection is performed via an open approach leading to significant potential postoperative complications and mortality. Today, Klatskin tumor resection is able to be performed minimally invasively using the robotic technique achieving lower incidence of postoperative complications, less pain, lower blood loss, and better short-term outcomes.

A smaller percentage of liver cancers (mostly ones located in central portion of the liver) also involve the main biliary duct and this requires biliary resection with reconstruction to achieve cure. This type of operation is technically more demanding, when compared to liver resection alone. A loop of small intestine (jejenum) is utilized to reconstruct the biliary system and to reestablish the normal biliary flow. This operation can now be safely performed using the robotic technique by experienced biliary surgeons such as Dr. Iswanto Sucandy and his team. Potential complications such as bile leak from the anastomosis and bile duct stricture can be minimized with a careful dissection and perfection in surgical technique.

We are one of only several liver surgery centers in the United States that offer robotic biliary resection and reconstructions for various bile duct diseases. Dr. Iswanto Sucandy and his team has a significant experience in this operation with excellent clinical outcomes. Most patients stay in the hospital for 5-6 days. A drain is placed during the operation and removed in the postoperative phase. It is important to find a Liver surgeon with significant expertise in bile duct surgery, in order to achieve a long-term success.