Hepatic Artery Infusion (HAI) Pump Placement For Unresectable Intrahepatic Cholangiocarcinoma with Vessel Abutment and Intrahepatic Metastasis
Rushin D. Brahmbhatt, MD
Penn State Health Milton S. Hershey Medical Center

The management of unresectable intrahepatic cholangiocarcinoma (ICC) faces major difficulties due to limited therapeutic options for liver-confined disease. A 72-year-old woman with a centrally-located ICC that involved both portal vein branches received robotic HAI pump placement. The procedure started with diagnostic laparoscopy before moving to robotic arterial dissection for catheter placement in the gastroduodenal artery (GDA) and ending with comprehensive perfusion testing using indocyanine green and methylene blue.

Preoperative imaging results showed less disease presence than the intraoperative ultrasound results that displayed multiple hepatic metastases, which led to a change in treatment approach from neoadjuvant to definitive palliative care. The surgeons confirmed proper hepatic perfusion and no abnormal extrahepatic blood flow after they placed the catheter successfully. The robotic HAI pump placement system provides a minimally invasive solution for delivering regional chemotherapy in cases of unresectable ICC through improved visualization and precision compared to open surgical approaches.