Abstract
Background: In this video we present a robotic assisted left hepatectomy with complex biliary reconstruction in a 61 year old female with morbid obesity (BMI 49 kg/m2) and non-alcoholic fatty liver disease. The patient presented with right upper quadrant abdominal pain. Evaluation with axial imaging and ERCP with biopsy confirmed a preoperative diagnosis of a left intrahepatic cholangiocarcinoma. Intraoperative ultrasound demonstrated unexpected tumor extension into the main hepatic ducts necessitating biliary resection and reconstruction. In this video we outline several techniques unique to minimally invasive hepatobiliary surgery that can be utilized to improve exposure and visualization in a patient with a challenging body habitus.
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