Robotic Choledochal Cyst Excision with Biliary Reconstruction

Choledochal cysts are uncommon congenital anomalies of the biliary tract, often presenting with abdominal pain, recurrent cholangitis, or obstructive jaundice. The definitive treatment is complete cyst excision with biliary-enteric reconstruction, which reduces the long-term risk of cholangiocarcinoma and recurrent biliary complications.

Traditionally performed by open surgery, this complex operation is increasingly being approached with minimally invasive techniques. The robotic platform, by virtue of its magnified three-dimensional vision and wristed instrumentation, allows for precise dissection and meticulous intracorporeal suturing, thereby expanding the scope of complex hepatobiliary reconstructions.

Methods and Results

A 46-year-old female presented with recurrent pancreatitis. MRCP revealed a type I choledochal cyst measuring 16 mm in diameter, with proximal biliary dilatation. A robotic- assisted complete cyst excision with Roux-en-Y hepaticojejunostomy was performed. The video demonstrates stepwise surgical details including meticulous dissection of the cyst from the porta hepatis and intrapancreatic bile duct, preparation of the jejunal Roux limb, and precise hand-sewn intracorporeal anastomosis. Intraoperative blood loss was 60 ml and operative duration was 260 minutes. The patient had an uneventful recovery, was discharged on postoperative day three, and remains well on follow-up with normal liver function tests.

Conclusion

Robotic excision of choledochal cyst with hepaticojejunostomy is a safe, feasible, and effective alternative to open surgery. The robotic platform provides superior ergonomics, enhanced dexterity, and high-definition visualization, which together facilitate complex biliary reconstruction in the confined space of the porta hepatis. This translates into favourable perioperative outcomes, precise anastomosis, and potentially durable long-term results.