Russell Woo, MD; David Le, MD; Craig T. Albanese, MD; Stephen S. Kim, MD
Although laparoscopic approach to the treatment of complex biliary disease is possible, it is technically challenging. In an attempt to overcome these difficulties, the da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA) was used to facilitate the minimally invasive treatment of a type I choledochal cyst in a 5 year-old, 22 kg girl. Complete resection of the choledochal cyst and a Roux-en-Y hepaticojejunostomy was performed using the robotic surgical system. Total robotic setup time (preparation, port placement, docking) was 40 minutes. Total procedure time was 440 minutes. Total robotic operating time was 390 minutes. No intraoperative complications or technical problems were encountered. At 6 months follow up, the child is doing well with no episodes of cholangitis. Robot-assisted laparoscopic type I choledochal cyst resection appears safe and feasible. The 3-dimensional visualization and wristed instrumentation greatly aids in the dissection of the cyst and in the biliary reconstruction.