Robotic-Assisted Laparoscopic Resection of Klatskin Tumors

Perihilar cholangiocarcinoma is a rare but challenging malignancy to treat affecting approximately 9000 patients in the United States per annum. Surgical resection remains the primary option for patients seeking curative treatment. This operation involves high technical complexities, including biliovascular dissections which can be complicated by tumor invasion of the surrounding structures within the porta hepatis. This often leads to the default use of the conventional open approach amid a minimally invasive revolution in the last several decades. However, with recent advancements in robotic hepatobiliary surgery, select patients may be offered a minimally invasive approach to resection if performed by experienced robotic hepatobiliary surgeons. This chapter outlines the patient selection criteria, preparation, operative approach, and postoperative management to undertake this operation successfully via a minimally invasive technique. Optimizing hepatic function preoperatively is vital for patients that will likely require concomitant major or extended hepatectomy. While the utilization of the robotic approach remains in its early stages, it signals advancements in surgical options for patients as more surgeons undergo training and gain experience in minimally invasive liver surgery.