(1)
Vinmec International Hospital, Hanoi, Vietnam
Abstract
Choledochal cyst is a rare condition in America and Europe. However, it is a common disease in Asian countries, especially Japan, China, and Vietnam. Laparoscopic cystectomy and hepaticojejunostomy for choledochal cyst was first performed by Farello in 1995. Nowadays, laparoscopic surgery is a routine procedure in the management of choledochal cyst in many centers.
Keywords
Choledochal cystLaparoscopicHepaticoduodenostomyHepaticojejunostomy26.1 General Information
Choledochal cyst is a rare condition in America and Europe. However, it is a common disease in Asian countries, especially Japan, China, and Vietnam. Laparoscopic cystectomy and hepaticojejunostomy for choledochal cyst was first performed by Farello in 1995. Nowadays, laparoscopic surgery is a routine procedure in the management of choledochal cyst in many centers.
26.2 Working Instruments
5- and 10-mm Hasson ports
30° and 0° telescopes
3- and 5-mm needle holders
3- and 5-mm scissors
3- and 5-mm Maryland forceps
26.3 Positioning, Port Siting, and Ergonomic Considerations
A nasogastric tube, rectal tube, and urinary Foley catheter are used to decompress the stomach, colon, and bladder, respectively. The patient is placed in a 30° head-up supine position. The surgeon stands at the lower end of the operating table between the patient’s legs (Fig. 26.1). A 10-mm trocar is inserted through the umbilicus for the telescope. Three additional 5- or 3-mm trocars are placed for instruments: one at the right flank, one at the left flank, and one in the left hypochondrium (Fig. 26.2). Carbon dioxide pneumoperitoneum is maintained at a pressure of 8–12 mmHg. For small infants, positioning across the table is preferable (Figs. 26.3 and 26.4).
Fig. 26.1
Patient position
Fig. 26.2
Trocar placement
26.4 Relevant Anatomy
Fig. 26.3
Operative photographs and illustrations of a choledochal cyst
Fig. 26.4
Operative photographs and illustrations of the relationship between a choledochal cyst and the portal vein
26.5 Surgical Technique
26.5.1 Cystectomy
The liver is secured to the abdominal wall with a stay suture placed at the round ligament. The cystic artery and duct are identified, clipped, and divided. A second traction suture is placed at the distal cystic duct and the gallbladder fundus to elevate the liver and splay the liver hilum (Fig. 26.5).
Fig. 26.5
A second traction suture is placed at the gallbladder fundus
The duodenum is retracted downward using a dissector through the fourth trocar site. The midportion of the cyst is dissected circumferentially. The cyst is separated from the hepatic artery and portal vein meticulously until a dissector can be passed through the space between the posterior cystic wall and the portal vein going from left to right (Fig. 26.6). The cyst then is divided at this site.
