Open injury, robotic repair–moving ahead! Total robotic Roux-en-Y hepaticojejunostomy for post-open cholecystectomy Bismuth type 2 biliary stricture using indocyanine green dye

Abstract

Hepaticojejunostomy is currently the best treatment for post-cholecystectomy biliary strictures. Laparoscopic repair has not gained popularity due to difficult reconstruction. We present case of 43-year-old-female with Bismuth type 2 stricture following laparoscopic converted open cholecystectomy with bile duct injury done elsewhere. Position was modified Llyod-Davis position and four 8-mm robotic ports (including camera) and 12-mm assistant port were placed. The procedure included noticeable steps such as adhesiolysis, identification of gallbladder fossa, identification of common hepatic duct, lowering of hilar plate etc. Operating and console time were 420 and 350 minutes and blood loss was 100 mL. Patient was discharged on postoperative day 4. Robotic repair (hepaticojejunostomy) of biliary tract stricture after cholecystectomy is safe and feasible with good outcomes.

Delayed Repair of E2 Bile Duct Injury With Robotic Roux-en-Y Hepaticojejunostomy

“…As surgeons accumulate more experience in minimally invasive bile duct surgery for benign and malignant tumors in the United States, the accepted surgical approaches gradually move from open to robotic technique. 4 Technical description of robotic RY hepaticojejunostomy is still very limited in the literature, and many high-volume hepatobiliary centers are still not familiar with its technical details. In this video, we describe our robotic technique for delayed repair of an E2 bile duct injury.…”