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Surgical Endoscopy

, Volume 30, Issue 12, pp 5626–5627 | Cite as

Robot-assisted hepatectomy and complete excision of the extrahepatic bile duct for type IV-A choledochal cysts

  • Ji Wool Ko
  • Sung Hoon ChoiEmail author
  • Sung Won Kwon
  • Kwang Hyun Ko
Video

Abstract

Background

Complete removal of the dilated biliary tree is regarded as inevitable in choledochal cysts due to its malignant potential. However, technical difficulty and the high risk of postoperative complications as well as the various presentations of the disease make the surgical options for type IV-A cysts challenging and controversial. We report the first case of a type IV-A choledochal cyst treated using a robot-assisted approach.

Patient and methods

A 41-year-old healthy female was admitted with intrahepatic and extrahepatic cysts incidentally found on routine checkup. Preoperative image studies showed two large cystic dilatations of the main biliary tract at the hilum and distal common bile duct as well as multiple cystic dilatations of the left intrahepatic duct. Anomalous pancreatico-biliary duct union was also found. The mid common bile duct was transected first, and the distal cystic bile duct of the intrapancreatic portion was resected at the junction with the pancreatic duct. The hilar cyst involved the right intrahepatic portion; therefore, liver resection proceeded to the right lobe, removing the caudate lobe. The right anterior and posterior hepatic ducts were securely isolated and resected with the help of real-time fluorescent imaging using an ICG. Roux-en-Y hepaticojejunostomy was performed intracorporeally.

Result

The total operation time was 540 min. The estimated amount of intraoperative bleeding was 750 ml. No blood transfusion was given. CT on postoperative day 6 showed no complications. Pathologic examination was accorded in choledochal cysts without evidence of malignancy. The patient was discharged on postoperative day 7 in good condition.

Conclusion

Hepatectomy and complete excision of the extrahepatic bile duct for type IV-A choledochal cysts requires fine and delicate surgical techniques. The wrist-like movement of the working instruments and the firefly imaging of the robot surgical system allowed this advanced minimally invasive surgery to be successfully performed on this patient.

Keywords

Bile Duct Choledochal Cyst Extrahepatic Bile Duct Bile Duct Cancer Distal Common Bile Duct 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The authors would like to express special thanks to Eun Hwa Lee (Medical student, CHA medical University, Seongnam, Republic of Korea) for the comprehensive narration of this multimedia article.

Compliance with ethical standards

Disclosures

Dr. Ji Wool Ko, Sung Hoon Choi, Sung Won Kwon, and Kwang Hyun Ko have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (WMV 298258 kb)

References

  1. 1.
    Jan YY, Chen HM, Chen MF (2000) Malignancy in choledochal cysts. Hepatogastroenterology 47(32):337–340PubMedGoogle Scholar
  2. 2.
    Ono S, Fumino S, Shimadera S, Iwai N (2010) Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10- to 27-year follow-up. J Pediatr Surg 45(2):376–378CrossRefPubMedGoogle Scholar
  3. 3.
    Watanabe Y, Toki A, Todani T (1999) Bile duct cancer developed after cyst excision for choledochal cyst. J Hepatobiliary Pancreat Surg 6(3):207–212CrossRefPubMedGoogle Scholar
  4. 4.
    Lenriot JP, Gigot JF, Segol P, Fagniez PL, Fingerhut A, Adloff M (1998) Bile duct cysts in adults: a multi-institutional retrospective study. French Associations for Surgical Research. Ann Surg 228(2):159–166CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Lee SE, Jang JY, Lee YJ, Choi DW, Lee WJ, Cho BH, Kim SW (2011) Choledochal cyst and associated malignant tumors in adults. Arch Surg 146(10):1178–1184CrossRefPubMedGoogle Scholar
  6. 6.
    Zheng X, Gu W, Xia H, Huang X, Liang B, Yang T, Yang S, Zeng J, Dong J (2013) Surgical treatment of type IV-A choledochal cyst in a single institution: children vs. adults. J Pediatr Surg 48:2061–2066CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Ji Wool Ko
    • 1
  • Sung Hoon Choi
    • 1
    Email author
  • Sung Won Kwon
    • 1
  • Kwang Hyun Ko
    • 2
  1. 1.Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical CenterCHA Medical UniversitySeongnam-siKorea
  2. 2.Department of Gastrointestinal Internal Medicine, CHA Bundang Medical CenterCHA Medical UniversitySeongnam-siRepublic of Korea

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