Fully laparoscopic resection of type X perihilar cholangiocarcinomas

Resection of perihilar cholangiocarcinoma remains one of the most demanding procedures in hepatobiliary surgery, owing to the complexity of hilar anatomy and the need for radical oncological resection combined with biliary reconstruction. These challenges are further amplified in type X tumors according to the Rennes classification, in which an extended left hepatectomy including the anterior sector and segment 1 (left trisectionectomy) is most often required: the long intersegmental plane of the posterior sector, the absence of external macroscopic landmarks, the frequent biliary and vascular anatomical variations on the right side, as well as the need for biliary reconstruction, make this surgery particularly complex. The laparoscopic approach remains limited due to these technical constraints, further compounded by the need for lymphadenectomy under laparoscopy, and is currently restricted to carefully selected patients in expert centers.