Laparoscopic Choledochal Cyst Resection with Hepaticoduodenostomy Using a Novel Articulating Instrument in a 19-Month-Old

Abstract

Introduction:

Historically, choledochal cyst excision has been performed as an open procedure. Controversy remains regarding managing this technically challenging entity in a minimally invasive manner.

Materials and Methods:

A novel mechanically designed intuitive articulating instrument is used to facilitate intracorporeal suturing when there is limited working space. The mechanical design of the three-axis Gimbal cuff facilitates intracorporeal suturing by providing intuitive wristed function to the surgeon by translating the surgeon's wrist movement to the end effector. This facilitated the hepaticoduodenostomy within the limited space of a pediatric porta.

Results and Conclusions:

We describe this novel technique in a 19-month-old who underwent laparoscopic choledochal cyst excision with an intracorporeal anastomosis facilitated by the novel laparoscopic instrument. This case demonstrates the use of the novel needle driver to sew an intracorporeal anastomosis within the porta of a 19-month-old obviating the need for robotic technology while expanding a laparoscopic surgeon's armamentarium.

K.E.S., C.N.G., and M.P. have no competing financial interests. J.D.G. is cofounder of FlexDex Surgical, Inc.

Runtime of video: 4 mins 2 secs

Presented at International Pediatric Endosurgery Group meeting in Santiago, Chile, in March 2019 as a video abstract.