Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):359-366. 10.14701/ahbps.2018.22.4.359.

Robot resection of a choledochal cyst with Roux-en-y hepaticojejunostomy in adults: Initial experiences with 22 cases and a comparison with laparoscopic approaches

• Han JH
• Lee JH
• Hwang DW
• Song KB
• Shin SH
• Kwon JW
• Lee YJ
• Kim SC
• Park KM

• KMID: 2427367
• DOI: http://doi.org/10.14701/ahbps.2018.22.4.359

Abstract

BACKGROUNDS/AIMS
In adult choledochal cysts, complete excision of cyst with Roux-en-Y hepaticojejunostomy by laparoscopy is typically been performed, but there is now a trend towards adopting robot-assisted resection.
METHODS
From January 2014 to December 2017, 22 patients who underwent robotic procedure were classified as Group 1, and 34 patients who underwent the same laparoscopic procedure as Group 2. In addition, from September 2009 to July 2011, 13 patients who underwent laparoscopic procedure were classified as Group 3. The perioperative outcomes and short-term postoperative morbidity levels were evaluated in three groups.
RESULTS
In all groups, there were more women than men, and the mean age and BMI did not differ significantly. Since 2014, jejunojejunostomy was performed extracorporeally and the mean operation time was shorter in Group 1 (258.5±52.9 min) and Group 2 (236.2±62.9 min) than Group 3 (395.2±85.9 min). [p=0.00 (1 vs 3), 0.00 (2 vs 3)] The median hospital stay was 7 days in Group 1 and 2, and shorter than 9 days in Group 3. [p=0.00 (1 vs 3), 0.011 (2 vs 3)] In Group 1, there were three postoperative complications, which included cholangitis, bile leakage and umbilical herniation, respectively). In Group 2, there were seven of postoperative complications, which included choledochojejunostomy site stricture & intrahepatic duct stone, choledochojejunostomy site stone, jejunal branch bleeding, portal vein thrombus, acute pancreatitis, adhesive ileus, and A-loop syndrome. In Group 3, there were three of postoperative complications, which included 2 hepaticojejunostomy site stricture and 1 paralytic ileus.
CONCLUSIONS
Robot-assisted resection of a choledochal cyst with Roux-en-y hepaticojejunostomy is a safe and feasible approach with short-term results that are comparable to those of laparoscopic surgery.

Keyword

Choledochal cyst; Robotic surgery; Laparoscopic surgery

MeSH Terms

Adhesives
Adult*
Bile
Cholangitis
Choledochal Cyst*
Choledochostomy
Constriction, Pathologic
Female
Hemorrhage
Humans
Ileus
Intestinal Pseudo-Obstruction
Laparoscopy
Length of Stay
Male
Pancreatitis
Portal Vein
Postoperative Complications
Thrombosis
Adhesives

Figure

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  Fig. 1 Site and size of the trocars in robotic procedure.

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  Fig. 2 Operative photographs. (A) Robotic view of choledochal cyst. (B) Distal portion of the choledochal cyst being ligated and resected. (C) A hepaticojejunostomy was performed intracorporeally.

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