Robotic left hepatectomy and Roux-en-Y right hepatico-jejunostomy for biliary papillomatosis

Computed tomography showing cystic dilatation of biliary tree with intramural components (arrow) The patient was placed in the reverse Trendelenburg position with legs spread apart, and a 5- to 12-mm subumbilical port was inserted with the establishment of carbon dioxide pneumoperitoneum. In a Korean series by Lee et al,2 curative resection was associated with significantly better survival (60 months in curative resection vs 36 months in palliative surgery group); similar results were demonstrated by another series of 18 cases in China.5 Due to the high propensity for diffuse involvement, recurrence and malignant transformation, timely diagnosis and radical resection remain the cornerstone for successful treatment. [...]hurdles can be overcome by robotic surgery: recent studies have shown that a robot-assisted approach offers a safe and feasible option for hepatobiliary surgery with promising results.6 7 8 9 10 The enhanced dexterity of EndoWrist (Intuitive Surgical Inc, Sunnyvale [CA], US), with its 7 degrees of freedom of movement, allows meticulous dissection and precise tissue handling, enabling intracorporeal suturing even in the most technically demanding areas that would otherwise be impossible to access in conventional laparoscopic surgery. [...]the robotic approach to treatment of biliary papillomatosis is feasible and safe in selected patients.