V3: Robotic Resection of Type I Choledochal Cyst with Roux-en-Y Hepaticojejunostomy

Introduction: Type I choledochal cysts are the most common type of choledochal cyst overall.  Surgical resection of the affected segment of the common bile duct is the recommended treatment for this diagnosis.  The robotic platform allows for this to be completed in a minimally invasive fashion, potentially limiting a portion of the morbidity seen with open hepatobiliary procedures.


Methods:


Results: The robotic instruments allow for fine dissection of the porta hepatis & excellent visualization of the hepatic arteries and portal vein during the circumferential dissection of the cyst and common bile duct.  Specific techniques utilized in this case include utilization of the gallbladder for retraction to limit trauma to the liver, cephalad retraction of the circumferentially dissected common duct with a silk suture to assist in visualization of the intrapancreatic portion of the duct, and pre-emptive partial closure of the distal common bile duct stump prior to its transection to prevent it from retracting into the pancreatic head after division of the duct.  The remainder of the Roux-en-Y hepaticojejunostomy is completed in a similar manner to our open technique.


Conclusions: Type I choledochal cyst resection with Roux-en-Y hepaticojejunostomy can be completed in a minimally-invasive fashion utilizing the robotic platform.  Specific techniques highlighted in the video can aid the surgeon in completing both the resection and reconstruction in a more efficient manner.