Robotically assisted laparoscopic Roux-en-Y hepaticojejunostomy

Abstract

Introduction: This study evaluates the feasibility and safety of using robotically assisted laparoscopy to perform a Roux-en-Y hepaticojejunostomy. This new method was compared with the open and standard laparoscopic approaches.

Methods: Eighteen pigs underwent a needlescopic common bile duct ligation to create a jaundice model. Three to 5 days later, transabdominal ultrasound was performed, and the common bile duct diameter was documented. For the Roux-en-Y hepaticojejunostomy, the pigs were randomly assigned to the open group (n=6), standard laparoscopy group (n=6), or robotically assisted laparoscopy group (Zeus) (n=6). One surgeon performed all 3 approaches with 1 assistant. Operative times, techniques, and complication rates were documented.

Results: The open approach was faster in all instances. At the hepaticojejunostomy, no difference was noted between the groups with the total number of stitches used. The robot required fewer stitches and less time in the posterior wall of the hepaticojejunostomy (P=-0.0083 and P=0.02049, respectively). The hepaticojejunostomy time was similar for the laparoscopy and robotically assisted groups.

Conclusion: Robotically assisted laparoscopic Roux-en-Y hepaticojejunostomy is a feasible procedure. When compared with standard laparoscopy, operating time is similar.

Figure 1.

Port placement in standard laparoscopy group and robotically assisted group (Zeus system, Computer Motion, Inc); Surgeon's instruments (A,B); Endocamera (AESOP) (C); Assistant (D,E,F).

Figure 2.

The Zeus system (Computer Motion, Inc.) incorporates 3 robotic arms (A). While voice control of the AESOP (B) manipulates remotely the laparoscopic camera, movements of robotic handles are transmitted to a computer controller translating the surgeon's movements to the robotic arms.

Figure 3.

Laparoscopic view of robotically assisted hepaticojejunostomy.