• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Robot-Assisted Biliary Reconstruction – Short-term Outcomes with Minimally-invasive Roux-en-Y Hepaticojejunostomy

Objective: A minimally invasive approach to hepatobiliary reconstruction can be technically difficult due to the need to suture a fine structure in an enclosed space, intimately related to critical vascular structures, often with significant adhesions or fibrosis. Using the da Vinci surgical system can aid in visualization and maneuverability, facilitating the dissection and anastomosis in this area. We examined our short-term outcomes with robot-assisted laparoscopic Roux-en-Y hepaticojejunostomy reconstruction.
Methods: We attempted a minimally invasive approach to biliary reconstruction in 8 patients from June 2007 to August 2008. Data from patients undergoing a minimally invasive approach to roux-en-Y hepaticojejunostomy were prospectively entered into a database, and patient characteristics, indications, operative data, and perioperative outcomes were recorded and analyzed retrospectively. 8 patients were explored laparoscopically with the intention of a minimally invasive biliary reconstruction. One patient underwent conversion to an open operation due to massive adhesions. The remaining 7 successfully underwent a robot-assisted laparoscopic roux-en-Y hepaticojejunostomy. The mean age of the patients was 58 (range 20-82); there were 5 males and 3 females.
Results: Indications for reconstruction included 3 benign common bile duct strictures from pancreatitis, 1 idiopathic benign stricture, 1 previous roux-en-Y hepaticojejunostomy reconstruction, 1 retained common bile duct stone after ERCP-related duodenal injury, 1 obstruction from pancreatic cancer, and 1 common bile duct injury after laparoscopic cholecystectomy. Mean operative time was 353 minutes (range 160-510); average estimated blood loss was 70ml (range 5 to 130ml). 6 of 8 patients had undergone preoperative biliary decompression. Size of the common hepatic duct ranged from 3mm to 18mm. Mean preoperative bilirubin was 1.9; all patients had a normal bilirubin by postoperative day 2. Average length of hospital stay was 4.9 days. There was no postoperative morbidity or mortality. No patients required a blood transfusion. One patient was readmitted for a short stay on postoperative day 3 for dehydration after being discharged on postoperative day 1.
Conclusion: A minimally invasive approach to complex biliary reconstructive operations is feasible and can be facilitated with the use of the da Vinci surgical system. The robotic camera provides a stable, magnified view of the operative field, and the Endo-wrist technology aids in the dissection and suturing of the delicate structures in the hepatic hilum. In addition, the fourth robotic arm is an invaluable tool in achieving extreme, stable retraction of the liver for exposure of the hilum. Further evaluation of long-term outcomes is necessary to determine if results are equivalent to traditional open surgery.


Session: Poster

Program Number: P435

View Poster

156

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons