Robotic Surgery for a Choledochal Cyst

Abstract

Purpose: Choledochal cyst are a rare congenital disease, traditionally treated with a complete excision and biliary tract reconstruction. Out purpose is to show our first robotic excision of a Type I choledochal cyst with a Roux-en-y-hepaticojejunostomy reconstruction. Method: A 19 years old patient was sent to our consultation after the diagnosis of choledochal cyst during a laparoscopic procedure. The preoperative MRI showed a large cyst of 31 × 20 × 21 mm (T × AP × CC) with prominence of the main hepatic duct and intrahepatic tract, without solid components and conserved distal choledochus. Gallbladder polyps were also described, with a maximum diameter of 10 mm. Results: The surgery was performed by Davinci Xi Robot. Classic Colecystectomy associated with choledochal cyst disection was performed as usual. Distal section of Choledochus was closed with running suture. Hepaticojejunostomy was created using 4/0 monofilament, double running suture. Mechanical jejunojejunostomy was completed with endoGIA 45mm. Postoperative period without incidences, with a hospital stay of 5 days. Conclusion: Robotic assisted surgery for choledochal cyst are feasible, offers a high precision and allows a minimal invasive reconstruction.