Therapeutics Advances
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1703-1706
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1703
Robotic assisted Roux-en-Y hepaticojejunostomy in a post-cholecystectomy type E2 bile duct injury
Arun Prasad, Sudipto De, Purak Mishra, Abhishek Tiwari
Arun Prasad, Sudipto De, Purak Mishra, Abhishek Tiwari, Department of Minimal Access and Robotic Surgery, Apollo Hospital, New Delhi 110076, India
Author contributions: Prasad A and De S designed the paper; Mishra P and Tiwari A performed the research; Prasad A and De S wrote the paper.
Conflict-of-interest: The authors have no competing commercial, political, personal, religious or intellectual interests related to the submitted work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Arun Prasad, MS, FRCS, FRCSEd, Senior Consultant Surgeon, Department of Minimal Access and Robotic Surgery, Apollo Hospital, Room 1268, 2nd Floor, New Delhi 110076, India. surgerytimes@gmail.com
Telephone: +91-11-29871250 Fax: +91-11-29871368
Received: August 4, 2014
Peer-review started: August 5, 2014
First decision: September 15, 2014
Revised: October 18, 2014
Accepted: December 14, 2014
Article in press: December 16, 2014
Published online: February 14, 2015
Abstract

Roux-en-Y hepaticojejunostomy anastomosis is the treatment of choice for common hepatic duct injury type E2. It has been performed laparoscopically with the advancement of laparoscopic skill. Recently, a telemanipulative robotic surgical system was introduced, providing laparoscopic instruments with wrist-arm technology and 3-dimensional visualization of the operative field. We present a case of 36-year-old female patient who had undergone elective cholecystectomy 2 mo ago for gall stones and had a common bile duct injury during surgery. As the stricture was old and complete it could not be tackled endoscopically. We did a laparoscopic assisted adhesiolysis followed by robotic Roux-en-Y hepaticojejunostomy. No intraoperative complications or technical problems were encountered. Postoperative period was uneventful and she was discharged on the 4th postoperative day. At follow-up, she is doing well without evidence of jaundice or cholangitis. This is the first reported case of robotic hepaticojejunostomy following common bile duct injury. The hybrid technique gives the patient benefit of laparoscopic adhesiolysis and robotic suturing.

Keywords: Hepaticojejunostomy, Common bile duct, Robotic surgery, Cholecystectomy complication, Hepatic duct

Core tip: Robotic surgery has the advantages of a 20 times magnified 3D vision for the surgeon. The intuitive and tremor free accurate movements of the robotic fingers make it an ideal tool to do fine reconstructive surgery. Hepaticojejunostomy is one such surgery specially when done for bile duct injury that occurred during cholecystectomy. We present the first ever reported robotic hepaticojejunostomy for iatrogenic bile duct injury.