Machado MA,Surjan R, Ardengh A, Makdissi F

Ann Surg Oncol

Robotic Left Hepatectomy and Roux-en-Y Hepaticojejunostomy After Bile Duct Injury

Background. Bile duct injuries after cholecystectomy
remain a major concern because their incidence has not
changed through the years despite technical advances. This
video presents a robotic left hepatectomy and Roux-en-Y
hepaticojejunostomy as a treatment for a complex bile duct
injury after laparoscopic cholecystectomy.
Methods. A 52-year-old man underwent laparoscopic
cholecystectomy at another institution 8 years previously,
which resulted in a bile duct injury. His postoperative
period was complicated by jaundice and cholangitis. He
was treated with endoscopic retrograde cholangiopancreatography
and multiple endoprostheses for 3 years, after
which the endoprostheses were removed, and he was sent
to the authors’ institution. Computed tomography showed
that the left liver had signs of disturbed perfusion and
dilation of the left intrahepatic bile duct. The patient was
asymptomatic and refused any further attempt at surgical
correction of the lesion. He was accompanied for 5 years.
Magnetic resonance imaging showed progressive atrophy
of the left liver. Finally, 3 months before this writing, he
presented with intermittent episodes of cholangitis. A
multidisciplinary team decided to perform left hepatectomy
with Roux-en-Y hepatojejunostomy via a robotic approach.
The left liver was atrophied, and left hepatectomy was
performed. Fluorescence imaging was used to identify the
right bile duct. At opening of the right bile duct, small
stones were found and removed. Antecolic Roux-en-Y
hepaticojejunostomy then was performed.
Results. The operative time was 335 min. Recovery was
uneventful, and the patient was discharged on postoperative
day 4.
Conclusions. Robotic repair of bile duct injuries is feasible
and safe, even when liver resection is necessary. This
video may help oncologic surgeons to perform this complex