Title: Suitability Of Robotic-assisted Surgery For Hepatic Peribiliary
Cysts: A Case Report
Authors: Seiya Yamamoto1(E-mail:seiya.yamamoto1029@gmail.com), Akihiko
Ueda 2(E-mail: akihikoueda93@gmail.com), Kenta Saito2(E-mail:
kentaxis777@gmail.com), Shuji Takiguchi2(E-mail:
shujitakiguchi@gmail.com)
1.Nagoya City University West Medical Center, Nagoya, Aichi 462-8508,
Japan
2.Department of Gastroenterological Surgery, Nagoya City University
Graduate School of Medical Sciences, Nagoya, Aichi 467-8601, Japan
Corresponding Author: Kenta Saito, Department of Gastroenterological
Surgery, Nagoya City University Graduate School of Medical Sciences,
Nagoya, Aichi 467-8601, Japan. E-mail: kentaxis777@gmail.com
Key Clinical Messages:
This study evaluates robotic-assisted surgery for hepatic peribiliary
cysts, demonstrating its suitability through a successful minimally
invasive subsegmentectomy on a symptomatic woman. Robotic surgery proved
effective, offering less invasive options with reduced complications and
recovery times, and may be preferable for managing potentially malignant
hepatic cysts.
Summary:
Although hepatic peribiliary cysts are generally benign, surgery may be
required if the cysts are growing or cause bile duct stenosis. However,
few studies have reported the use of robotic surgery for removing
hepatic peribiliary cysts. This case report describes a woman in her 50s
with a cystic lesion in liver segment III that increased from 33 to 45
mm in 2 years. The patient was asymptomatic; however, robotic
subsegmentectomy of segment III was performed owing to concerns about
potential malignancy. The cyst was lined by a single layer of
cylindrical epithelium without cytological atypia, and was
pathologically diagnosed as a hepatic peribiliary cyst. Hepatic
peribiliary cysts can be monitored if the cyst was diagnosed correctly
and the patient has no symptoms. However, surgery is warranted if
malignancy cannot be ruled out or the patient is symptomatic. Minimally
invasive robotic surgery may be a good option for hepatic peribiliary
cysts.
Keywords: Hepatic peribiliary cysts, Robotic surgery, Minimally invasive
surgery, Hepatectomy, Case report
Background:
Hepatic peribiliary cysts are benign lesions that are thought to occur
when inflammation causes obstruction of the secretory channels of the
peribiliary glands around large bile ducts [1]. The age at the time
of diagnosis of hepatic peribiliary cysts is in the 60s, and men are
more frequently affected than women [1]. Although hepatic
peribiliary cysts are benign, surgery is sometimes indicated when the
cyst obstructs the bile duct and causes jaundice or cholangitis [2,
3] or when the cyst increases in size and is difficult to distinguish
from other malignant cystic tumors [4]. However, it is difficult to
definitively diagnose hepatic peribiliary cysts as malignant, and
minimally invasive surgery should be chosen when there is a possibility
of benign disease. Furthermore, minimally invasive robotic surgery has
recently become popular and has been shown to be safe for liver
resection [5].
In the present case, we chose surgery as a treatment strategy for a
growing hepatic peribiliary cyst that was difficult to distinguish from
a tumor with malignant potential. The patient underwent robot-assisted
hepatic subsegmentectomy with good outcomes.
Case Presentation: