title: Robotic resection of choledochocele in an adult with intracorporeal hepaticojejunostomy and Roux-en-Y anastomosis: encouraging progress for robotic surgical treatment of biliary disease.
abstract: BACKGROUND
  Robotic surgery offers three-dimensional visualization and precision of movement that could be of great value to hepatobiliary surgeons. Previous reports of robotic choledochocele resections in adults have detailed extracorporeal jejunojejunostomies. We describe a total robotic excision of a choledochal cyst with hepaticojejunostomy and intracorporeal Roux-en-Y anastomosis.
  
  
  METHODS
  A 58-year-old woman underwent a robotic excision of a small choledochocele with hepaticojejunostomy and intracorporeal Roux-en-Y.
  
  
  RESULTS
  Port placement was determined via collaborative surgical discussion and previously reported robotic right hepatectomies. Total operative time was 386 min and total robot working time was 330 min. The hepaticojejunostomy was performed using 5-0 PDS suture with parachute-style back wall and running front wall sutures. The jejunojejunostomy was a stapled anastomosis. Estimated blood loss was less than 100 mL. The patient was ambulating and tolerating oral intake on post-operative day 1, and was discharged home on post-operative day 2.
  
  
  CONCLUSIONS
  Robotic resection of choledochal cyst with intracorporeal Roux-en-Y anastomosis is feasible, with advantages over open surgery such as superior visualization, precision, and post-operative patient recovery.
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA. carpenter.susanne@mayo.edu.
authors.forename: S G
authors.initials: SG
authors.lastname: Carpenter
authors.affiliation: Department of Urology, Mayo Clinic Arizona, Phoenix, AZ, 85054, USA.
authors.forename: G
authors.initials: G
authors.lastname: Grimsby
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: T
authors.initials: T
authors.lastname: DeMasters
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: N
authors.initials: N
authors.lastname: Katariya
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Hewitt
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Moss
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Reddy
authors.affiliation: Department of Urology, Mayo Clinic Arizona, Phoenix, AZ, 85054, USA.
authors.forename: E P
authors.initials: EP
authors.lastname: Castle
authors.affiliation: Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ, 85054, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Mulligan
keywords: Choledochal cyst; Choledochocele; Minimally invasive hepatobiliary surgery; Robotic hepatobiliary surgery