Strategies and methods for laparoscopic-assisted and robotic-assisted R₀ resection of perihilar cholangiocarcinoma

Perihilar cholangiocarcinoma is a malignant tumor originating from the biliary tract epithelium. Due to its unique biological behavior, radical resection remains the most effective treatment currently, with patient survival rate highly correlated with R₀ resection. However, perihilar cholangiocarcinoma tends to invade and spread to the hilar structures, often necessitating complex surgical procedures with low R₀ resection rate. In recent years, with the continuous development of laparoscopic and robotic technology, many domestic and international centers have successfully performed laparoscopic-assisted and robotic-assisted radical resection of perihilar cholangiocarcinoma, even including vascular resection and reconstruction. R₀ resection remains the essential of surgery, and some centers have begun to use the SpyGlass DS digital single‑operator cholangioscopy system for preoperative intraluminal localization of tumor in the bile duct. There are also attempts to use SpyGlass system in combination with intraductal ultrasound, optical coherence tomography, confocal laser endomicroscopy and other techniques, to assist surgeons in accurately determining the resection margins, thereby achieving better R₀ resection. Based on previous literature and team experiences, the authors elaborate on the strategies and methods for laparoscopic-assisted and robotic-assisted R₀ resection of perihilar cholangiocarcinoma.