Hepatic Artery Infusion (HAI) Pump Placement For Unresectable Intrahepatic Cholangiocarcinoma with Vessel Abutment and Intrahepatic Metastasis

1. Introduction

2. Diagnostic Laparoscopy and Placement of Robotic Ports

3. Robot Docking

4. Liver Ultrasound

5. Liver Retraction

6. Pars Flaccida Incision and Gastrohepatic Ligament Takedown to Expose Station 8a Lymph Node

7. Station 8a Lymph Node Dissection to Expose Common Hepatic Artery and Gastroduodenal Artery

8. Common Hepatic Artery, Proper Hepatic Artery, and GDA Dissection and Division of Branches to Duodenum to Prevent Aberrant Flow

1. Right Gastric Artery Ligation
2. Ligation of a Suspected Aberrant Branch of GDA
3. Station 8a Lymph Node Excision

9. Creation of Subcutaneous Pocket for Pump

10. Hepatic Artery Infusion Pump Placement

11. ICG and Methylene Blue Tests to Rule Out Aberrant Flow

12. Hemostasis, TAP Blocks, and Robot Undocking

13. Placement of Pump in Subcutaneous Pocket

14. Closure

15. Post-op Remarks