ASO Authors Reflections: Could Robotics, 3D Imaging, and Liver Venous Deprivation Potentially Redefine Surgical Standards for Perihilar Cholangiocarcinoma?

Abstract

Peri-hilar cholangiocarcinoma remains a major challenge in hepatobiliary surgery, where safety of surgical operation and oncological radicality (R0 resection) are primary goals. Traditional open surgery, including major hepatectomy with caudate lobe and bile duct resection plus lymphadenectomy, remains the standard. Recent advances-robotic platforms, 3D imaging, and liver venous deprivation-offer new possibilities: liver venous deprivation ensures sufficient future liver remnant, and robotics provide precise dissection and enhanced visualization. Although costs and the learning curve remain limiting factors, these strategies could safely expand the use of minimally invasive surgery in peri-hilar cholangiocarcinoma. Validation in larger cohorts is required to assess their true potential.