Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 20;408(1):284.
doi: 10.1007/s00423-023-03020-1.

Innovative suture technique for robotic hepaticojejunostomy: double-layer interrupted sutures

Kosei Takagi  1 , Yuzo Umeda  2 , Ryuichi Yoshida  2 , Tomokazu Fuji  2 , Kazuya Yasui  2 , Takahito Yagi  2 , Toshiyoshi Fujiwara  2
Affiliations

Innovative suture technique for robotic hepaticojejunostomy: double-layer interrupted sutures

Kosei Takagi et al. Langenbecks Arch Surg. .

Abstract

Purpose: Biliary reconstruction remains a technically demanding and complicated procedure in minimally invasive hepatopancreatobiliary surgeries. No optimal hepaticojejunostomy (HJ) technique has been demonstrated to be superior for preventing biliary complications. This study aimed to investigate the feasibility of our unique technique of posterior double-layer interrupted sutures in robotic HJ.

Methods: We performed a retrospective analysis of a prospectively collected database. Forty-two patients who underwent robotic pancreatoduodenectomy using this technique between September 2020 and November 2022 at our center were reviewed. In the posterior double-layer interrupted technique, sutures were placed to bite the bile duct, posterior seromuscular layer of the jejunum, and full thickness of the jejunum.

Results: The median operative time was 410 (interquartile range [IQR], 388-478) min, and the median HJ time was 30 (IQR, 28-39) min. The median bile duct diameter was 7 (IQR, 6-10) mm. Of the 42 patients, one patient (2.4%) had grade B bile leakage. During the median follow-up of 12.6 months, one patient (2.4%) with bile leakage developed anastomotic stenosis. Perioperative mortality was not observed. A surgical video showing the posterior double-layer interrupted sutures in the robotic HJ is included.

Conclusions: Posterior double-layer interrupted sutures in robotic HJ provided a simple and feasible method for biliary reconstruction with a low risk of biliary complications.

Keywords: Biliary complications; Hepaticojejunostomy; Pancreatoduodenectomy; Robotic surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Robotic hepaticojejunostomy (HJ) using posterior double-layer interrupted sutures. A The first suture was established at the left corner of the bile duct (right side of the patient). The 5–0 PDS sutures were always placed from the bile duct to the jejunum. B Following the placement of the second suture covering the corner suture, a posterior double-layer technique was applied. The suture was placed in the bile duct and posterior seromuscular layer of the jejunum (arrow). C Thereafter, the full thickness of the jejunum was bitten (arrow). D Following completion of the posterior layer anastomosis, the intraluminal corner suture was placed on the right side of the bile duct (left side of the patient). E For anterior layer anastomosis, interrupted stay sutures were placed and ligated. F Robotic HJ anastomosis using posterior double-layer interrupted sutures was finished
Fig. 2
Fig. 2
The differences between double- and single-layer hepaticojejunostomy anastomoses. A Posterior double-layer interrupted sutures. The bite of the posterior seromuscular layer of the jejunum could cover posterior side of the anastomotic site. Covering the posterior side of the bile duct could prevent minor bile leakage. B Single single-layer sutures. The bile duct tearing at the anastomosis could lead to bile leakage
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kamarajah SK, et al. A systematic review and network meta-analysis of different surgical approaches for pancreaticoduodenectomy. HPB (Oxford) 2020;22(3):329–339. doi: 10.1016/j.hpb.2019.09.016. - DOI - PubMed
    1. Aiolfi A, et al. Systematic review and updated network meta-analysis comparing open, laparoscopic, and robotic pancreaticoduodenectomy. Updates Surg. 2021;73(3):909–922. doi: 10.1007/s13304-020-00916-1. - DOI - PMC - PubMed
    1. El Nakeeb A, et al. Biliary leakage following pancreaticoduodenectomy: Prevalence, risk factors and management. Hepatobiliary Pancreat Dis Int. 2019;18(1):67–72. doi: 10.1016/j.hbpd.2018.10.005. - DOI - PubMed
    1. Farooqui W, et al. Biliary Leakage Following Pancreatoduodenectomy: Experience from a High-Volume Center. J Pancreat Cancer. 2021;7(1):80–85. doi: 10.1089/pancan.2021.0014. - DOI - PMC - PubMed
    1. Honda G, et al. Basic knowledge of and a small trick for atraumatic needle driving in laparoscopic suturing. J Hepatobiliary Pancreat Sci. 2020;27(10):785–788. doi: 10.1002/jhbp.814. - DOI - PubMed

Publication types

LinkOut - more resources