Hybrid Laparoscopic-Robotic Management of Type IVa Choledochal Cyst in the setting of prior Roux-en-Y Gastric Bypass
Presented by Julietta Chang at the SAGES 2014 Meeting; Panel – Concurrent Session SS2 Video 1
Julietta Chang, MD, R. Matthew Walsh, MD, Kevin El-Hayek; Cleveland Clinic Foundation
Points of interest:
Explanation of choledochal cysts–11 sec
Todani classification–38 sec
patient presentation–48 sec
MRCP–1:32
reconstructive options–1:48
laparoscopic port placement–3:19
Keyword(s): 12 mm assistant trocar, 12 mm camera, 12 mm robotic camera, 12 mm trocar, 3D optics, 5 mm trocar, 5mm robotic trocar, advancement of minimally invasive hepaticobiliary techniques, alk phos levels, altered GI anatomy, anastomotic stricture, anatomic location, associated complications, at risk of malnutrition, bile gastritis, bile stasis, biliary system, biliary tree, biliary-enteric reconstruction, biliopancreatic limb, blood supply, cholangiogram catheter, cholangitis, classification system, clipped, concepts, current standard, cystic duct, delineating, depression, diagnosis, dilation of CBD, disadavantages, discharged, dissection, distal stalk, distally, docked, EBL, end to side hepaticoduodenostomy, endoscopic access, endoscopic treatment, enhanced articulation, entero-enteric anastomosis, entry to the ABD, epigastrium, esophagitis, extrahepatic biliary dilatation, extrahepatic biliary tree, extrahepatic choledocal cyst, female, final pathology, frozen histology, full mobilization, further workup, future risk of malignancy, future surveillance, gallbladder, gallbladder fossa, gastric remant, hepatic duct, hepatic ductotomy, hilum, hook electrocautery, HTN, hybrid laparoscopic-robotic management, incidence, increased risk of anastomotic leak, indication, infundibulum of the gallbladder, initial BMI, inspected for hemostasis, intermittent right ABD pain, interrrupted 4-0 PDS, IOC, jaundice, knots of anterior wall, knots of posterior wall, Kocher maneuver, laparoscopic port placement, laparoscopic resection of the choledochal cyst with robotic assisted biliary enteric reconstruction, laparoscopic Roux-en-Y gastric bypass, lateral aspect, LFTs, liver, lumen, malabsorptive function, malignant potential, mild intrhepatic dilation, mobilizing duodenum, morbidly obese population, morphology, MRCP, Nathanson liver retractor, negative for dysplasia or carcinoma, negative for malignancy, negative margins, no complaints, no planned intervention, obesity epidemic, operative time, optical trocar, pancreatic duct, pancreatitis, patient presentation, physiologic drainage of bile, planning, PMH, POD 3, porta hepatis, post bypass BMI, post-op course, pre-op work-up, prior to presentation, proximal stalk, PSH, pyloroplasty, rare congential disease, recommended management, reconstructive options, remant stomach, resection recommended, risk of malignancy, robot, robotic port placement, Roux limb, Roux-en-Y hepaticojejunostomy, second Roux limb, shortened common limb, specimen bag, specimen resected, status post bariatric surgery, surgical excision, technical ease, tension on the anastomosis, Todani classification, transverse duodenostomy, triangle of calot, trimmed edge, Type 4a choledochal cyst, type IV choledochal cyst, ultrasonic shears, umbilical site, umbilicus, undocked, undue tension, uneventful, upper ABD, W configuration, workup for bariatric surgery, yearly follow up