Skip to main content
SpringerLink
Log in

Robotic-assisted Roux-en-Y hepaticojejunostomy after bile duct injury

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

The Da Vinci Robotic Surgical System has positioned itself as a tool that improves the ergonomics of the surgeon, facilitating dissection in confined spaces and enhancing the surgeon’s skills. The technical aspects for successful bile duct repair are well-vascularized ducts, tension-free anastomosis, and complete drainage of hepatic segments, and all are achievable with robotic-assisted approach.

Methods

This was a retrospective study of our prospectively collected database of patients with iatrogenic bile duct injury who underwent robotic-assisted Roux-en-Y hepaticojejunostomy. Pre-, intra-, and short-term postoperative data were analyzed.

Results

A total of 30 consecutive patients were included. The median age was 46.5 years and 76.7% were female. Neo-confluences with section of hepatic segment IV were performed in 7 patients (those classified as Strasberg E4). In the remaining 23, a Hepp-Couinaud anastomosis was built. There were no intraoperative complications, the median estimated blood loss was 100 mL, and the median operative time was 245 min. No conversion was needed. The median length of stay was 6 days and the median length of follow-up was 8 months. The overall morbidity rate was 23.3%. Two patients presented hepaticojejunostomy leak. No mortality was registered.

Conclusion

Robotic surgery is feasible and can be safely performed, with acceptable short-term results, in bile duct injury repair providing the advantages of minimally invasive surgery. Further studies with larger number of cases and longer follow-up are needed to establish the role of robotic assisted approaches in the reconstruction of BDI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. De Santibañes E, Palavecino M, Ardiles V, Pekolj J (2006) Bile duct injuries: management of late complications. Surg Endosc 20(11):1648–1653. https://doi.org/10.1007/s00464-006-0491-8

    Article  PubMed  Google Scholar 

  2. Mercado MA, Franssen B, Domínguez I, Arriola-Cabrera JC, Ramírez-del Val F, Elnecavé-Olaiz A, Arámburo-Garcia R, García A (2011) Transition from a low-to a high-volume center bile duct repair: changes in technique and improved outcome. HPB (Oxford) 13(11):767–773. https://doi.org/10.1111/j.1477-2574.2011.00356.x

    Article  Google Scholar 

  3. Chapa-Azuela O, Ortiz-Higareda V, Etchegaray-Dondé A, Cruz-Martínez R, Hernández-Mejía BI (2013) Tratamiento quirúrgico de las lesiones iatrogénicas de la vía biliar. Rev Med Hosp Gen Mex 76(1):7–14

    Google Scholar 

  4. Liu Y, Yao X, Li S, Liu W, Liu L, Liu J (2014) Comparison of therapeutic effects of laparoscopic and open operation for con- genital choledochal cysts in adults. Gastroenterol Res Pract 2014:670260

    PubMed  PubMed Central  Google Scholar 

  5. Ng JL, Salim MT, Low Y (2014) Mid-term outcomes of laparoscopic versus open choledochal cyst excision in a tertiary paediatric hospital. Ann Acad Med Singap 43(4):220–224

    PubMed  Google Scholar 

  6. Aguirre-Olmedo I, Cuendis-Velázquez A, Morales-Chávez CE, Torres-Ruiz MF, Rojano-Rodríguez ME, Cárdenas-Lailson LE (2013) Laparoscopic choledochoduodenostomy as an optional treatment choledocholithiasis. Cir Cir 81(2):118–124

    PubMed  Google Scholar 

  7. Chander J, Mangla V, Vindal A, Lal P, Ramteke VK (2012) Laparoscopic choledochoduodenostomy for biliary stone disease: a single-center 10-year experience. J Laparoendosc Adv Surg Tech A 22(1):81–84. https://doi.org/10.1089/lap.2011.0366

    Article  PubMed  Google Scholar 

  8. Kondratiuk OP, Khil’ko IO, Kondratiuk VA, Kravchenko DA (2014) Laparoscopic hepaticojejunostomy in patients with inoperable tumour of pancreatic head. Klin Khir 4:64–65

    Google Scholar 

  9. Cuendis-Velázquez A, Morales-Chávez C, Aguirre-Olmedo I, Torres-Ruiz F, Rojano-Rodríguez M, Fernández-Álvarez L, Cárdenas-Lailson E, Moreno-Portillo M (2016) Laparoscopic hepaticojejunostomy after bile duct injury. Surg Endosc 30(3):876–882. https://doi.org/10.1007/s00464-015-4282-y

    Article  PubMed  Google Scholar 

  10. Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR (2002) Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology 60(1):39–45. https://doi.org/10.1016/S0090-4295(02)01717-X

    Article  PubMed  Google Scholar 

  11. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180(1):101–125

    CAS  PubMed  Google Scholar 

  12. Winslow ER, Fialkowski EA, Linehan DC, Hawkins WG, Picus DD, Strasberg SM (2009) “Sideways”: result of repair of biliary injuries using a policy of side-to-side hepatico-jejunostomy. Ann Surg 249(3):426–434. https://doi.org/10.1097/SLA.0b013e31819a6b2e

    Article  PubMed  Google Scholar 

  13. Hepp J, Couinaud C (1956) Approach to and use of the left hepatic duct in reparation of the common bile duct. Presse Med 64(41):947–948

    CAS  PubMed  Google Scholar 

  14. Mercado MA, Chan C, Orozco H, Tielve M, Hinojosa CA (2003) Acute bile duct injury. The need for a high repair. Surg Endosc 17(9):1351–1355. https://doi.org/10.1007/s00464-002-8705-1

    Article  CAS  PubMed  Google Scholar 

  15. Mercado MA, Orozco H, de la Garza L, Lopez-Martinez LM, Contreras A, Guillen-Navarro E (1999) Biliary duct injury: partial segment IV resection for intrahepatic reconstruction of biliary lesions. Arch Surg 134(9):1008–1010. https://doi.org/10.1001/archsurg.134.9.1008

    Article  CAS  PubMed  Google Scholar 

  16. Strasberg SM, Picus DD, Drebin JA (2001) Results of a new strategy for reconstruction of biliary injuries having an isolated right-sided component. J Gastrointest Surg 5(3):266–274. https://doi.org/10.1016/S1091-255X(01)80047-0

    Article  CAS  PubMed  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  18. Macedo FI, Casillas VJ, Davis JS, Levi JU, Sleeman D (2013) Biliary-colonic fistula caused by cholecystectomy bile duct injury. Hepatobiliary Pancreat Dis Int 12(4):443–445. https://doi.org/10.1016/S1499-3872(13)60070-3

    Article  PubMed  Google Scholar 

  19. Prasad A, De S, Mishra P, Tiwari A (2015) Robotic assisted Roux-en-Y hepaticojejunostomy in a post-cholecystectomy type E2 bile duct injury. World J Gastroenterol 21(6):1703–1706. https://doi.org/10.3748/wjg.v21.i6.1703

    Article  PubMed  PubMed Central  Google Scholar 

  20. Giulianotti PC, Quadri P, Durgam S, Bianco FM (2017) Reconstruction/repair of iatrogenic biliary injuries, is the robot offering a new option? Short clinical report. Ann Surg 267(1):e7–e9. https://doi.org/10.1097/SLA.0000000000002343

    Article  Google Scholar 

  21. Schwenk W, Hasse O, Neudecker J, Muller JM (2005) Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev 20(3):CD003145

    Google Scholar 

  22. Zhang Y, Chen XM, Sun DL (2014) Laparoscopic versus open distal pancreatectomy: a single-institution comparative study. World J Surg Oncol 12(1):327. https://doi.org/10.1186/1477-7819-12-327

    Article  PubMed  PubMed Central  Google Scholar 

  23. Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2014) Meta-analysis of laparoscopic vs open cholecystectomy in elderly patients. World J Gastroenterol 20(46):17626–17634. https://doi.org/10.3748/wjg.v20.i46.17626

    Article  PubMed  PubMed Central  Google Scholar 

  24. Bablekos GD, Michaelides SA, Analitis A, Charalabopoulos KA (2014) Effects of laparoscopic cholecystectomy on lung function: a systematic review. World J Gastroenterol 20(46):17603–17617. https://doi.org/10.3748/wjg.v20.i46.17603

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gonzalez-Ciccarelli LF, Quadri P, Daskalaki D, Milone L, Gangemi A, Giulianotti PC (2016) Robotic approach to hepatobiliary surgery. Chirurg 88(Suppl 1):19–28

    Google Scholar 

  26. Ismael HN, Cox S, Cooper A, Narula N, Aloia T (2017) The morbidity and mortality of hepaticojejunostomies for complex bile duct injuries: a multi-institutional analysis of risk factors and outcomes using NSQIP. HPB (Oxford) 19(4):352–358. https://doi.org/10.1016/j.hpb.2016.12.004

    Article  Google Scholar 

  27. Iannelli A, Paineau J, Hamy A, Schneck AS, Schaaf C, Gugenheim J (2013) Primary versus delayed repair for bile duct injuries sustained during cholecystectomy: results of a survey of the association Francaise de Chirurgie. HPB (Oxford) 15(8):611–616. https://doi.org/10.1111/hpb.12024

    Article  Google Scholar 

  28. Boerma A, Rauws EA, Keulemans YC, Bergman JJ, Obertop H, Huibregtse K, Gouma DJ (2001) Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg 234(6):750–757. https://doi.org/10.1097/00000658-200112000-00006

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Walsh RM, Henderson JM, Vogt DP, Brown N (2007) Long-term outcome of biliary reconstruction for bile duct injuries from laparoscopic cholecystectomies. Surgery 142(4):450–456. https://doi.org/10.1016/j.surg.2007.07.008

    Article  PubMed  Google Scholar 

  30. Savader SJ, Lillemoe KD, Prescott CA, Winick AB, Venbrux AC, Lund GB, Mitchell SE, Cameron JL, Osterman FA Jr (1997) Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg 225(3):268–273. https://doi.org/10.1097/00000658-199703000-00005

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Dageforde LA, Landman MP, Feurer ID, Poulose B, Pinson CW, Moore DE (2012) A cost-effectiveness analysis of early vs late reconstruction of iatrogenic bile duct injuries. J Am Coll Surg 214(6):919–927. https://doi.org/10.1016/j.jamcollsurg.2012.01.054

    Article  PubMed  Google Scholar 

  32. Wormer BA, Dacey KT, Williams KB, Bradley JF 3rd, Walters AL, Augenstein VA, Stefanidis D, Heniford BT (2014) The first nationwide evaluation of robotic general surgery: a regionalized, small but safe start. Surg Endosc 28(3):767–776. https://doi.org/10.1007/s00464-013-3239-2

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Dr. Florencio de la Concha Bermejillo, who helped in the edition of this paper, as well as all the referring surgeons who trusted our team for the treatment of their patients.

Author information

Authors and Affiliations

  1. Department of General and Endoscopic Surgery, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14090, Mexico City, Mexico

    Adolfo Cuendis-Velázquez, Orlando Bada-Yllán, Mario Trejo-Ávila, Enrique Rosales-Castañeda, Andrés Rodríguez-Parra, Alberto Moreno-Ordaz, Eduardo Cárdenas-Lailson, Martin Rojano-Rodríguez, Carlos Sanjuan-Martínez & Mucio Moreno-Portillo

Authors
  1. Adolfo Cuendis-Velázquez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Orlando Bada-Yllán
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mario Trejo-Ávila
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Enrique Rosales-Castañeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrés Rodríguez-Parra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alberto Moreno-Ordaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eduardo Cárdenas-Lailson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin Rojano-Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Carlos Sanjuan-Martínez
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mucio Moreno-Portillo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Drs. Adolfo Cuendis-Velázquez, Orlando Bada-Yllán, Mario Trejo-Ávila, Enrique Rosales-Castañeda, Andrés Rodríguez-Parra, Alberto Moreno-Ordaz, Eduardo Cárdenas-Lailson, Martin Rojano-Rodríguez, Carlos Sanjuan-Martínez, and Mucio Moreno-Portillo contributed equally in study conception and design, acquisition of data, analysis and interpretation of data drafting of manuscript, and critical revision of manuscript.

Corresponding author

Correspondence to Adolfo Cuendis-Velázquez.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding information

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cuendis-Velázquez, A., Bada-Yllán, O., Trejo-Ávila, M. et al. Robotic-assisted Roux-en-Y hepaticojejunostomy after bile duct injury. Langenbecks Arch Surg 403, 53–59 (2018). https://doi.org/10.1007/s00423-018-1651-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-018-1651-8

Keywords

Search

Navigation