Robotic choledochojejunostomy with intracorporeal Roux limb construction

Background: Biliary surgery can often be very complex, with difficult access issues, small structures to be manipulated and sutured and proximity to major vessels. Additionally, biliary surgery is often reoperative. All of these issues have the potential to be aided by the use of technology which provides three-dimensional (3D) vision, excellent illumination and access, with steady instrument control under maximal magnification. The robot is such a technology which is currently available. Methods: The Da Vinci® robot was used to perform a robotic choledochojejunostomy, using five ports and a totally intracorporeal technique. Results: Two patients were studied. There were no conversions to open operation. There was no mortality. One patient experienced a postoperative bile leak, which was successfully managed endoscopically. Conclusions: Robotic choledochojejunostomy with intracorporeal Rou-xen-Y anastomosis is a feasible operation with a definite learning curve. It has potential benefits to the patient.