Robot-Assisted Excision of a Choledochal Cyst with Hepaticoduodenostomy in a Pediatric Patient

Abstract

Introduction:

Choledochal cysts are a group of congenital cystic malformations that lead to dilation of the biliary tract and require surgical excision caused by the risk of malignant degeneration. ¹ Although controversy remains regarding the optimal technique for choledochal cyst resection, minimally invasive approaches have been increasingly utilized. ^2,3 This adoption has been facilitated by the rise in the use of hepaticoduodenostomies. ⁴ We demonstrate a robot-assisted excision of a large type I choledochal cyst with hepaticoduodenostomy reconstruction in a pediatric patient.

Materials and Methods:

The patient is an 11-year-old girl who was found to have a large symptomatic choledochal cyst after admission for cholangitis, requiring antibiotics and endoscopic retrograde cholangiopancreatography. Magnetic resonance cholangiopancreatography demonstrated dilation of the common bile duct that did not extend intrahepatically. Cyst excision with bilioenteric reconstruction was recommended.

Results:

Using the Da Vinci Xi platform, one laparoscopic assistant port, and the Firefly system with indocyanine green, the biliary anatomy was defined. The choledochal cyst was fully dissected to its junction with the pancreatic duct and excised. An intracorporeal hepaticoduodenostomy was performed after kocherization of the duodenum to confirm a tension-free reconstruction. A cholecystectomy was performed and a drain was left in the gallbladder fossa. The patient progressed as expected postoperatively and was discharged on postoperative day 3 with drain removal before discharge.

Conclusions:

Robot-assisted choledochal cyst excision with hepaticoduodenostomy is a safe operation with effective biliary tree drainage. The robotic approach allows for increased observation and technical dissection advantage as well as straightforward intracorporeal suturing. ⁵

Acknowledgment:

The source of the study is the Division of Pediatric Surgery at Penn State Milton S. Hershey Medical Center.

Patient Consent:

Author(s) have received and archived patient consent for video recording/publication in advance of video recording of the procedure.

The authors have no conflicts of interest or funding to disclose.

Runtime of video: 5 mins 19 secs

This video was presented at the American College of Surgeons Clinical Congress on October 25, 2023, in Boston, MA, USA.