Robotic Choledochal Cyst Excision Roux En Y Hepatico jejunostomy
Education event Sponsored by: Intuitive Surgical
Conference Name: Pediatric Event Robotic Choledochal Cyst Excision
Conducted by: Intuitive Surgical & Dr. Basant Kumar and Dr. Ankur Mandelia.
Surgeon(s)/Speaker(s): Dr. Basant Kumar and Dr. Ankur Mandelia
Surgical Procedure: Oncology-Roux-En-Y Hepatico-Jejunostomy
Location: SGPGI, Lucknow
Indexsteps
1. Patient is placed in supine position : With small roll under the upper abdomen
2. 4 robotic ports and 1 assistant port are inserted : As shown in video and robot is docked
3. Liver and gall bladder are retracted cranially : By trans-cutaneous “hitch” sutures
4. Cystic artery and duct are dissected, clipped and divided :
5. The choledochus is dissected free from the portal vein, hepatic artery, duodenum and pancreas :
6. Posterior plane with portal vein is achieved and choledochal cyst is hitched up : With trans-cutaneous suture
7. Distal intra-pancreatic dissection is done till tapering of bile duct is seen : Which is then clipped and divided
8. Anterior wall of the cyst is then incised distal to the cystic duct-common hepatic duct (CHD) junction : And the cyst is inspected from inside for any possible aberrant duct orifice.
9. Circumferential transaction is then done at an appropriate level of CHD :
10. A 40 cm Roux‐en‐Y jejunal loop is fashioned : With endoscopic linear stapler-cutter
11. Roux loop is delivered to the porta : Via a retro-colic route
12. Hepatico-jejunostomy is then fashioned in interrupted fashion : Using 5-0 polygalactin or polydioxanone sutures
13. Specimen is retrieved, peritoneal lavage is given and drain is inserted :
14. Jejuno-jejunostomy is then performed extra-corporeally : Via an enlarged umbilical incision
15. Check laparoscopy is done and port sites are closed in layers :
port positions
1. Port position for Roux-En-Y Hepatico-Jejunostomy : 4 robotic ports and 1 assistant port
Surgical Instruments
1. Da Vinci Xi Surgical System
2. Maryland Bipolar forceps
3. Monopolar curved scissor
4. Cadiere / Prograsp forceps
5. Mega Suture Cut needle driver
6. Medium-large Hemlock applier
7. Suction Irrigation canula
8. 5mm Needle Holder
9. Bowel Grasper
10. 5mm scissor
11. Stapler
