Surgical Fellow Digestive Health Institute Tampa, United States
Objectives: The traditional open approach is the main surgical technique utilized for the repair and reconstruction of bile duct injury after laparoscopic cholecystectomy. In the last decade, minimally invasive surgery has grown in popularity as a new technique in biliary surgery. The laparoscopic approach to creating biliary anastomosis is associated with increased surgical difficulty and a lack of precision needed in fine biliary surgery. Technical description of the robotic approach for bile duct injury reconstruction is very limited in the digital literature.
Methods: In this video, we describe the techniques used in four types of biliary injury repair after laparoscopic cholecystectomy by Roux-en-Y hepaticojejunostomy reconstructions. A running method using 4-0 absorbable barbed sutures was used with TF-1 needles. The first operation involves an E2 bile duct injury reconstruction. The second is an E3 bile duct injury reconstruction. The third is an E4 bile duct injury repair and the final technique demonstrates an isolated right posterior sectoral bile duct reconstruction. A closed suction drain was placed after each bile duct reconstruction.
Results: The robotic approach is associated with technical precisions leading to similar technical outcomes to the traditional open approach.
Conclusion: Minimally invasive robotic bile duct reconstruction can be used as an alternative to the traditional open approach. This video depicts the safety and efficacy of this technique for four different types of biliary reconstructions.
