Robotic transanastomotic stenting via Witzel technique in complex hepaticojejunostomy for biliary tract tumors

Hepaticojejunostomy after biliary tract tumors resection represents the main limitation to minimally invasive approaches application in this field. Robotic surgery is emerging as an attractive option, offering enhanced three-dimensional visualization and articulated instruments that allow for precise intracorporeal suturing. We present our series of robotic hepaticojejunostomy with Witzel-style transanastomotic stenting.

This dynamic manuscript provides a comprehensive overview of the robotic Witzel technique hepaticojejunostomies, focusing on technical aspects and postoperative outcomes.

Nine patients underwent a robotic Witzel-hepaticojejunostomy, eight for oncologic diseases. Surgical procedures included four bile duct resections alone and four associated with major hepatectomies. All hepaticojejunostomy were built upon a Roux-an-Y jejunal loop, with an antecolic path in seven cases. The prevalent suturing technique was a mixed technique, combining continuous barbed suture for one wall with an interrupted suture for the other. The median operative time was 630 min (593-705), median blood loss was 100 ml (100-350), and no intraoperative blood transfusions were required. Postoperative complications occurred in 3 patients (Clavien-Dindo 3a), without any post-hepatectomy liver failure nor biliary complications. R0 was achieved in 6 out of 8 curative resections and median retrieved nodes were 8.5 (4.5-16.3). After a mean follow-up of 12.6 ± 8 months, 4 (50%) patients developed recurrence within 3 and 27.5 months after surgery.

Robotic Witzel-technique hepaticojejunostomy is feasible even in complex anatomical contexts, and safe, as demonstrated by the absence of biliary complications in the present series.