Robotic hepaticojejunostomy: surgical technique and risk factor analysis for anastomotic leak and stenosis

Abstract

Background: A variety of techniques have been described for the construction of the HJ (hepaticojejunostomy). Due to its technical challenges, HJ is rarely performed in a pure laparoscopic setting. In stark contrast, the increasing availability of the robotic platform has sparked new interest in pursuing this procedure in a minimally invasive fashion. The aim of our study was to describe our surgical technique and to identify risk factors for anastomotic leak and stenosis following robotic surgery. Methods: We performed a retrospective analysis of a prospectively collected database, including all consecutive HJ carried out for different indications over a 10 year period.Results: One hundred fifty-two patients undergoing robotic HJ performed by the same surgeon were analyzed. Bile leak occurred in 2.6% of the patients. Stricture rate was 3.3%. The median follow up was 25.5 months. There was no mortality related to anastomotic complications. On univariate analysis, patient's age less than 65 years was the only risk factor for anastomotic stricture. On multivariate analysis, no predictor factors for leak or stenosis were identified. Conclusion:HJs carried out in a robotic fashion allow highly satisfactory results. No independent risk factors for bile leak of stenosis were identified on multivariate analysis.

Innovative suture technique for robotic hepaticojejunostomy: double-layer interrupted sutures

“…Therefore, more attention should be paid to preventing biliary complications. In the setting of minimally invasive surgery, data on surgical techniques and outcomes following robotic HJ are limited [ 9 , 15 ]. In the present study, we presented a unique surgical technique, posterior double-layer interrupted sutures, in robotic HJ.…”

“…However, the best HJ technique remains debatable. This is because interrupted sutures could have a higher risk of anastomotic leak, whereas continuous sutures are more prone to anastomotic stenosis [ 9 , 27 ].…”

“…However, no optimal HJ technique has been demonstrated to be superior to other surgical techniques for preventing biliary complications [ 8 ]. Moreover, few studies have reported the surgical techniques of robotic HJ [ 9 ].…”

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

“…A minimally invasive technique, especially the laparoscopic approach, is used by surgeons primarily for type 1 and 2 strictures but has yet to gain popularity due to the technical challenges encountered, mainly during reconstruction. There are minimal data on the robotic approach for the repair of post-cholecystectomy biliary strictures [ 4 , 5 ].…”

Feasibility, safety and limits of robotic approach for lymphadenectomy in biliary tumours

“…Finally, the scarce proportion of perihilar cholangiocarcinoma included in this study did not allow to evaluate robotic confection of hepaticojejunostomy which is supposed to be one of the major improvements in minimally invasive liver surgery with reported anastomotic fistulae and stenosis rates close to those of open surgery ( 10 ). Likewise, vascular resections and arterial or venous reconstructions often realised for perihilar cholangiocarcinoma surgery, and described as safe with the use of robot in selected patients for pancreatic resection in literature ( 11 , 12 ), were not studied.…”