Ayloo Subhashini, Schwartzman Jacob
Department of Surgery, Rutgers, New Jersey Medical School, Newark, New Jersey.
J Laparoendosc Adv Surg Tech A. 2019 Jun;29(6):817-819. doi: 10.1089/lap.2018.0664. Epub 2018 Dec 14.
Common bile duct (CBD) injury is a serious complication of laparoscopic and open cholecystectomy. Early identification and minimally invasive repair, when possible, can prevent much of the morbidity associated with this injury. A 36-year-old woman referred in the immediate perioperative period for CBD injury at the time of laparoscopic cholecystectomy. We present a case of early robot-assisted repair of a Strasberg class E bile duct injury with Roux-en-Y hepaticojejunostomy. Total console time of 4 hours with minimal blood loss and no requirement for transfusion with length of stay of 3 days. No intra- or perioperative complications of the surgery were noted. The degrees of freedom and stability of the robotic platform were instrumental during several key steps, including exposure of the hepatic hilum, positioning of the Roux limb, and suturing of the CBD. Successful minimally invasive repair of this patient's CBD injury minimized the morbidity of the index operation, blood loss, hospital length of stay, and potential legal consequences.
胆总管（CBD）损伤是腹腔镜胆囊切除术和开腹胆囊切除术的严重并发症。早期识别并在可能的情况下进行微创修复，可以预防与此损伤相关的大部分发病率。一名36岁女性在腹腔镜胆囊切除术中发生CBD损伤，在围手术期立即转诊。我们报告一例采用Roux-en-Y肝空肠吻合术对Strasberg E级胆管损伤进行早期机器人辅助修复的病例。总手术时间为4小时，失血极少，无需输血，住院时间为3天。未发现手术的术中或围手术期并发症。机器人平台的自由度和稳定性在几个关键步骤中发挥了重要作用，包括肝门暴露、Roux袢定位和胆总管缝合。该患者的CBD损伤成功进行微创修复，将初次手术的发病率、失血量、住院时间和潜在法律后果降至最低。
