Luis Fernando Gonzalez Ciccarelli, Jason Zimmermann, Mario Masrur, Roberto Bustos, Francesco Bianco, Pier Giulianotti. University of Illinois Hospital and Health Sciences System
Background: Iatrogenic bile duct injuries are a major concern in open and laparoscopic cholecystectomies. Inappropriate exposure, surgeon inexperience, variable biliary anatomy, aggressive attempts to perform hemostasis and inflammation of the porta are the most commons risk factors. Robot-assisted surgery has shown to have technical advantages over open and laparoscopic techniques.
Materials and methods: We report a case of a 57 year-old male with a history of common bile duct (CBD) injury after a laparoscopic cholecystectomy in an outside hospital. Patient was transferred in stable condition to this institution for management of an iatrogenic CBD injury after the specimen removed intraoperatively showed a portion of the stent placed of common bile duct. A CT scan performed showed postsurgical changes of laparoscopic cholecystectomy and a stent placed in the CBD with a small complex fluid collection within the gallbladder fossa. Patient was elected to undergo a robotic assisted Roux-n-Y hepaticojejunostomy.
Results: The operative time was 225 minutes. During dissection of the hepatic hilum using the robotic needle driver and hook, we identified 2 structures that were draining bile, the right and left hepatic duct. The CBD was sectioned at the confluence of the hepatic ducts. A type III injury was identified. Using a roux of limb from the jejunum we performed a hepaticojejunostomy. The overall estimated time was 225 min, estimated blood loss was 100 ml. No intraoperative or post-operative complications. Patient was discharged from the hospital in stable conditions on his postoperative day 5. Three months follow up the patient was asymptomatic with normal liver function test.
Conclusions: Robot assisted reconstruction of iatrogenic bile duct injuries is feasible, safe and may be an option in expert hands. The enhanced vision, endowristed instruments, fine dissection and microsuturing provided by the robotic system allows a safe and precise reconstruction on the liver hilum.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88195
Program Number: V070
Presentation Session: Robotics 1 Session
Presentation Type: Video