Robotic assisted minimally invasive hepaticojejunostomy in complex biliary strictures, a feasible option.

Manoj Gupta, MS, DNB, Surgical, Gastroenterology, Neeraj Dhamija, DNB, General, Surgery, Abhideep Chaudhary, MS, General, Surgery, Saumitra Rawat, K R Vasudevan. Sir Gangaram Hospital, New Delhi

Background:

Minimally invasive surgery for complex biliary reconstructions is a technical difficult procedure. Though the initial report of laparoscopic bile duct stricture repair emanated from our centre, the difficulty in performing a hepaticojejunostomy high-up in the liver hilum prevented its widespread adoption.The shortcomings of conventional laparoscopic surgery are overcome by the availability of advanced robotic surgical system. We present our experience with the use of robot assisted minimally invasive hepaticojejunostomy in complex biliary strictures.

Material and Methods:

We did two cases between September 2013 and January 2014. Both of the patients had post laparoscopic cholecystectomy type II billiary strictures. One of them had cholangitis preoperatively, which was managed with PTBD. In both cases, combined laparoscopic and robotic surgical approach was used. Standard procedure steps were followed for both cases.

Results:

Postoperatively patients had uneventful recovery. In patient who had preoperative cholangitis followed by PTBD, liver functions recovered slowly within two weeks. Both the patients were followed up for more than six months postoperatively with excellent outcomes.

Conclusions:

This first report of robotic bile duct stricture repair celebrates the union of bio-technology and surgical expertise to overcome a perceptibly elusive frontier. We anticipate this will stimulate the proactive development of a new genre of 'peri-hepatic minimally invasive surgery' as a viable alternative to 'open' bile-duct surgery, and not to be passed off as marketing gimmickry.

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