Introduction
Resection of the common bile duct is the treatment of choice for type I choledochal cysts found in adults. The procedure can portend a significant morbidity because of the large incision required for adequate exposure. Robotic surgery provides excellent visualization and fine manipluation of the biliary system with minimized morbidity to the patient.
Methods
A 26 yr old female required excision of large type I choledochal cyst. The Da Vinci Si Robot System (Intuitive Surgical, Sunnyvale, CA) was utilized to assist resection.
Results
Port placement was similar to standard robotic cholecystectomy ports, with slight alterations to facilitate possible roux-en-Y hepaticojejunostomy in case a hepaticoduodenostomy was not possible. Operative time was less than 210 minutes, estimated blood loss was 100 mL. Aberrant anatomy was identified in that the right anterior bile duct coursed over the right posterior bile duct before inserting separately from the common hepatic duct confluence into the choledochal cyst. The common bile duct was dissected to the level of the pancreatic parenchyma and then ligated using hem-o-lok clips (Teleflex Medical, Research Triangle, NC). The hepaticoduodenostomy was constructed using 3-0 vicryl sutures with a running back wall and an interrupted front wall. The patient progressed well post-operatively and was discharged home post-operative day four after an uncomplicated hospital course.
Conclusion
Robotic resection of choledochl cyst with hepaticoduodenostomy is a feasible technique that confers the advantages over open technique such as fine movements, superior visualization and improved post-operative pain and return to function.