Robot Roux-en-Y hepaticojejunostomy

Abstract

Presenter: Tadahiro Uemura MD, PhD | Allegheny Health Network Background: Laparoscopic Roux-en-Y hepaticojejunostomy remains technicallychallenging. Robot-assisted laparoscopic surgery is rapidly expanding in many surgical fields. We applied robot assisted technique for Roux-en-Y hepaticojejunostomy. Methods: A 81 year old female presented with right upper quadrant abdominal pain found to have choledocholithiasis. She underwent ERCP twice, but it failed due to tight stricture of lower common bile duct. She was referred to us for Roux-en-Y hepaticojejunostomy Results: Da Vinci Xi system was used. Four 8 mm robotic ports and one 12 mm assistant port were placed in lower abdomen. After adhesiolysis, common bile duct was exposed. Indocyanine Green was injected preoperatively and common bile duct was also confirmed under fluorescence. Jejuno-jejunostomy was created with Endo GI stapler and staple site was closed with Albert-Lembert suture. Roux limb was brought up to liver hilum retro colic fashion. Common hepatic duct was incised longitudinally incised and stones were removed. Hepatocojejunostomy was created with side to side anastomosis in interrupted sutures. The patient had no post-operative complication and discharged on POD 5. Conclusion: Robot Roux-en-Y hepaticojejunostomy can be performed with similar fashion of open Roux-en-Y hepaticojejunostomy.