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: