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

Area of Science:

• Minimally invasive surgery
• Hepatopancreatobiliary surgery
• Surgical techniques

Background:

• Biliary reconstruction is complex in minimally invasive hepatopancreatobiliary surgery.
• No single hepaticojejunostomy (HJ) technique is definitively superior for preventing biliary complications.
• Robotic surgery offers potential advantages in complex procedures.

Purpose of the Study:

• To evaluate the feasibility of a novel posterior double-layer interrupted suture technique for robotic hepaticojejunostomy (HJ).
• To assess the safety and efficacy of this technique in preventing biliary complications.
• To provide an alternative method for biliary reconstruction in robotic surgery.

Main Methods:

• Retrospective analysis of prospectively collected data from 42 patients.
• Robotic pancreatoduodenectomy with the posterior double-layer interrupted HJ technique.
• Sutures involved the bile duct, jejunum's posterior seromuscular layer, and full jejunal thickness.

Main Results:

• Median operative time: 410 minutes; median HJ time: 30 minutes.
• Median bile duct diameter: 7 mm.
• Low complication rate: 2.4% bile leakage (Grade B), 2.4% anastomotic stenosis; 0% perioperative mortality.

Conclusions:

• The posterior double-layer interrupted suture technique is a simple and feasible method for robotic HJ.
• This technique demonstrates a low risk of biliary complications.
• It represents a viable option for biliary reconstruction in robotic hepatopancreatobiliary surgery.