Robotic Roux-en-Y Hepaticojejunostomy in a Post-cholecystectomy Bile Duct Injury

Robotic surgery has the advantages of 20 times magnified 3D high definition vision for the surgeon. The intuitive and tremor free wrist articulation with accurate movements of the robotic fingers makes it an ideal tool to do fine reconstructive CBD surgery. Hepaticojejunostomy is one such surgery specially when done for bile duct injury that occurred during cholecystectomy. We present the robotic hepaticojejunostomy for iatrogenic bile duct injury.

Roux-en-Y hepaticojejunostomy anastomosis is the treatment of choice for common hepatic duct injury type E2. It has been performed laparoscopically by many expert laparoscopic surgeons with the advancement of laparoscopic skill. Recently, da Vinci robotic surgical system was introduced, providing laparoscopic instruments with wrist-arm technology and 3-dimensional visualization of the operative field.

We present a case video above of 45-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 7th 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 in India. 

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