Robotic-assisted laparoscopic Roux-en-Y choledochojejunostomy in pigs

Area of Science:

• Minimally Invasive Surgery
• Surgical Innovation
• Gastrointestinal Surgery

Background:

• Common bile duct (CBD) reconstruction often involves complex procedures.
• Robotic-assisted surgery offers potential advantages in precision and control.
• Evaluating new techniques in novice surgeons is crucial for adoption.

Purpose of the Study:

• To assess the feasibility of robotic-assisted laparascopic Roux-en-Y choledochojejunostomy for CBD reconstruction.
• To evaluate the learning curve for an operator without prior robotic experience.
• To determine the safety and efficacy of this technique in a porcine model.

Main Methods:

• Ten pigs underwent robotic-assisted Roux-en-Y choledochojejunostomy after gallbladder removal.
• Three pigs were used for procedural refinement; seven underwent a one-week postoperative survival period.
• Postoperative evaluation included laparotomy, assessment for complications, and intraoperative cholangiography.

Main Results:

• All pigs demonstrated competent anastomoses, indicating successful reconstruction.
• Two pigs experienced mortality due to gastric retention from Roux-en-Y sling suspension issues.
• Cholangiography revealed no extrahepatic stenosis or intrahepatic dilatation; liver parameters remained unaffected.

Conclusions:

• Robotic-assisted Roux-en-Y choledochojejunostomy is a straightforward and effective procedure for biliary reconstruction.
• The technique successfully establishes biliary drainage and maintains intestinal continuity.
• Operating times decreased, approaching those of experienced surgeons, suggesting a manageable learning curve.