Introduction : Hilar cholangiocarcioma is considered as contraindication to the laparoscopic approach related mainly to the necessity of vascular dissection and a bilioenteric anastomosis. However with the development of minimally invasive pancreatoduodenctomy, we become more familiar with hepatic pedicle dissection, biliary anastomosis and even vascular resection-anastomosis. We present a video of laparoscopic left hepatectomy for hilar cholangiocarcinoma.

Methods : Hilar cholangiocarcinoma was discovered on jaundice in a 72 year old male and treated efficiently by endoscopic drainage. Lesion was located on the biliary confluence with left extension and no vascular invasion. The laparoscopic approach was decided and five trocars were used.

Results : The operative duration was 360 minutes; the blood loss was 200 ml, with isolated clampage of the portal vein of 30 minutes. The postoperative stay was marked by biliary fistula with spontaneous healing at POD 5 and the patient was discharged home at POD 14. Histology confirmed the diagnosis of a well differentiated cholangiocarcinoma of 3 cm with perineural invasion and no vascular invasion, 15 harvested negative lymph nodes and R0 resection (T2bN0R0).

Conclusions : The development and experience with laparoscopic pancreatoduodenctomy will increase the feasibility of some difficult liver resections by the laparoscopic approach including hilar cholangiocarcinoma.