Intraoperative Video Consultation Following Bile Duct Transection Facilitates Direct OR Transfer for Robotic...

Bile duct injuries during cholecystectomy are most frequently attributed to misidentification of surgical anatomy. Initial management following a major bile duct injury is time-sensitive and critical to the patient's clinical course and overall outcome. We present a 63-year-old male patient who sustained a common bile duct transection during laparoscopic cholecystectomy at a resource-limited rural surgery center. Upon recognition of the injury, an intraoperative video consultation was made to hepatobiliary surgery at our academic referral institution, providing a real-time explanation of the dissection with direct visualization of surgical anatomy. This expedited sequence facilitated acquisition of diagnostic studies, including an intraoperative cholangiogram, confirming common bile duct transection, and a CT angiogram, demonstrating intact arterial anatomy. Direct to OR transfer to the tertiary facility was therefore prioritized, circumventing a prolonged bed wait the patient would have otherwise required while awaiting injury diagnosis and characterization. He underwent definitive repair with robotic-assisted Roux-en-Y hepaticojejunostomy on the same day that the injury occurred. This paper provides an operative video with a concise and adoptable method for performing a definitive hepaticojejunostomy following bile duct transection intended for fellowship-trained hepatobiliary surgeons.