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This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr. Raja Kalayarasan, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India Abstract: Robotic hilar bile duct resection for hilar biliary tumors Introduction Major hepatectomy is often indicated in patients with hilar biliary tumours to achieve tumor-free margin. However, major hepatectomy is associated with significant morbidity, especially in patients with poor hepatic function. Hence, balancing the radicality of surgery with operative safety is critical. A better understanding of the surgical anatomy of the hepatic hilum allows us to perform parenchyma-preserving liver resection for these tumours. The use of a robotic approach for hilar bile duct resection has not been previously reported. Methods The technique is indicated in patients with type I and II hilar tumours without vascular involvement and those with low-grade hilar tumours without infiltration beyond the bile duct. Level I (sectoral)hilar bile ducts can be approached without liver resection, whereas level II (segmental) hilar bile ducts require liver resection. The procedure was performed with the Davinci Xi robotic system using four robotic trocars and two assistant trocars. Results Seven patients underwent this procedure. The indications were intraductal papillary neoplasm of bile duct in 3 patients. Gallbladder cancer with bile duct involvement in 2 patients and hilar cholangiocarcinoma in two patients. The median operative time was 410 minutes. One patient had a grade B postoperative bile leak. Conclusion Hilar bile duct resection is feasible in selected patients with hilar biliary tumours. A robotic approach might be the preferred minimally invasive technique for hilar bile duct resection. See more at: http://vattikutifoundation.com/