[7].
Hepatic peribiliary cysts are benign lesions that can be
monitored without intervention after being accurately diagnosed.
However, in Japan, surgery is performed in cases in which malignancy
cannot be completely ruled out, in patients with jaundice, and in
patients with repeated episodes of cholangitis [2]. If the cyst is
located around a large bile duct near the porta hepatis and is
impossible to distinguish from a malignant tumor, open hepatic resection
is generally performed [2]; however, there is one reported case in
which laparoscopic surgery was performed in Japan [2]. Open surgery
is considered highly invasive, and minimally invasive surgery should be
chosen if possible, especially for benign tumors. In the present case,
it was difficult to rule out malignancy, so we decided to perform
minimally invasive robotic surgery in accordance with recent reports of
the effectiveness of minimally invasive robot-assisted liver resection
[5].
In our case, the patient was female and the imaging findings
were somewhat atypical because the cyst did not form a series of beads,
making it difficult to distinguish from hepatic mucinous cystic
neoplasm. In addition, the cyst had increased in size during 2 years of
follow-up, so the possibility of malignancy could not be ruled out.
Therefore, surgery was chosen. We decided to perform
robotic-assisted hepatectomy because it is less invasive with less
intraoperative bleeding and less postoperative pain than open surgery
[5].
The perihilar accessory glands are also of interest as a source
of intraductal papillary neoplasms of the bile duct and
cholangiocarcinomas, and there are reports of cholangiocarcinoma thought
to have originated from hepatic peribiliary cysts [6].
Therefore, as more cases are accumulated and a relationship between
hepatic peribiliary cysts and cholangiocarcinoma is suggested, surgery
may become the treatment of choice for hepatic peribiliary
cysts.
In conclusion, the diagnosis rate of hepatic peribiliary cystsis expected to improve with advances in imaging technology.
However, there are cases, such as the present case, in which surgery is
warranted. In the present case, robot-assisted hepatic subsegmentectomy
was performed safely and achieved good results. Our results suggest that
robotic surgery may be useful for the treatment of hepatic peribiliary
cysts for which surgery cannot be avoided.