Robotic Revision of Hepaticojejunostomy

Sushruta S. Nagarkatti, MD; Erin H. Baker, MD; David A. Iannitti, MD, FACS; Dionisios V. Vrochides, MD, PhD, FACS, FRCSC; John B. Martinie, MD, FACS

Product Details
Product ID: ACS-5600
Year Produced: 2018
Length: 9 min.


Our video describes the use of the da Vinci Surgical System Xi (Intuitive Surgical, Sunnyvale, CA) to perform a robotic revision hepaticojejunostomy. The patient is a 60 year old male with a history of chronic pancreatitis, choledocholithiasis, and benign biliary strictures. He underwent multiple ERCP's and ultimately an open Roux-en-Y choledochojejunostomy (end to side) eight years ago at an outside facility. He did well for seven years following surgery but recently re-presented with abdominal discomfort and elevated LFT's. MRI revealed diffuse intrahepatic and proximal common duct dilation with multiple stones extending into the right and left hepatic ducts. EUS and FNA were performed to rule out possible malignancy and results were negative. As such, we felt this represented a benign stricture of the previous anastomosis. Extensive adhesiolysis was performed and intra-operative ultrasound was used to identify the structures in the porta hepatis. The proximal common bile duct and roux limb were freed from adhesions. The prior anastomosis was taken down with the robotic scissors. The enterotomy was closed with running suture in single layer. The strictured area of the duct was resected and sent for pathology, (approx. 2cm). A new anastomosis was then created using 4-0 absorbable monofilament barbed sutures between the more proximal hepatic duct and the jejunum.