Robotic resection of type IV choledochal cyst with complete extra-hepatic bile duct resection and left hepatectomy with Roux-en-Y right hepaticojejunostomy

Abstract

Background: A 20 year-old healthy female was admitted for abdominal pain, was found to have acute pancreatitis lipase level was 2950. Initial abdominal ultrasound showed a markedly dilated bile duct suspicious for choledochal cyst. Surgery team was consulted. MRCP was ordered, which showed a type IV choledochal cyst involving the entire extra-hepatic bile duct, and extending into the left extra- and intra-hepatic bile ducts. The right main and intra-hepatic bile ducts were spared. Methods: Surgical plan: Robotic complete extra-hepatic bile duct resection of the entire choledochal cyst, cholecystectomy, left hepatectomy, and roux-en-y right hepaticojejunostomy. Specimen was retrieved from abdomen via a 5 cm Pfannenstiel incision. Operative time 300 minutes. EBL 150 ml Pathology: Fibrotic cystic wall with erosion consistent with choledochal cyst, negative for dysplasia/malignancy Results: Post-operative Course The patient had an uneventful recovery and was discharge on POD #6 , with normal liver functions tests. 2 and 6-week clinic follow up – no issues On follow up at 6 months postoperatively, patient was doing great. Lab work normal. Conclusion: Robotic resection of type IV choledochal cyst with Roux-en-Y reconstruction is safe, feasible, and affords the patient the benefits of a minimally invasive surgery, including quick recovery and short length of hospital stay