Application of robotic-assisted hepatopancreatoduodenectomy in non-jaundiced gallbladder cancer patient with invasion of the common bile duct: A case report
Kai Xu, Guodong Chen, Chen Liu, Wanghong Li, Xin Li, Guilin Cao, Longhua Zhang, Jintian Tang, Chao Yi, Feng Xue, Liping Liang, Deliang Cao, Boqing WangRationale:
Hepatopancreatoduodenectomy (HPD) is a surgical procedure utilized for the curative-intent resection of biliary tract malignancies. However, there is a paucity of literature documenting the application of robotic-assisted HPD in case of gallbladder cancer (GBC) with invasion into the common bile duct (CBD) in patients who had no jaundice.
Patient concerns:
One week before admission, a 58-year-old female suffered from paroxysmal diarrhea and vomiting without any apparent cause.
Diagnoses:
Preoperative computed tomography (CT) and magnetic resonance imaging revealed GBC with dilation of the CBD and common hepatic duct. Intraoperative choledochoscopy revealed a soft tissue mass (0.5–1 cm) at the distal CBD near the duodenal papilla with circumferential involvement. Given the primary GBC, metastatic involvement of the distal CBD was suspected.
Interventions:
After discussion, robotic-assisted HPD by the da Vinci Xi system was performed. The surgery lasted 580 minutes with 200 mL of blood loss. Postoperative pathology indicated malignant tumors of the gallbladder and bile duct.
Outcomes:
The patient’s postoperative vital signs were stable. The CT scan results from the one-year postoperative follow-up showed no signs of tumor recurrence or metastasis.
Lessons:
This case supports the viability and safety of the robotic approach to HPD for complex biliary malignancies, establishing it as a feasible minimally invasive strategy in well-selected cases, contingent upon surgical expertise.