Robotic Biliary Reconstruction Procedures

Robotic Surgery for Bile Duct Cancer

The bile duct is an important structure that brings bile from the liver to the intestine, traveling through the pancreas on the way to the intestine (where it exits into the piece of intestine called the duodenum). About 4,000 Americans are diagnosed with cancer of the bile duct (cholangiocarcinoma) each year. Since the bile duct lies deep within the abdomen, open surgery for this condition requires a very large abdominal incision. However, bile duct cancer can now also be treated very effectively with minimally invasive surgical approaches, including robotic surgery.

The type of robotic procedure performed to treat bile duct cancer depends on the location of the tumor. Tumors in the bile duct can be located in the top portion of the bile duct (near the liver), the middle portion, or the lower portion (near the pancreas). For tumors in the top portion, surgery involves removing a segment of the bile duct and, at times, a portion of the liver. For tumors in the middle of the bile duct, we can often remove a segment of the bile duct alone. For tumors in the lower part of the bile duct, some nearby pancreas may need to be removed as well.

Whichever portion of the diseased bile duct is removed, these surgical approaches always involve a procedure called biliary reconstruction, in which the surgeon reshapes a piece of intestine to help connect the remaining bile duct with the small intestine and reestablish the flow of bile from the liver into the intestinal tract. This is typically done using a surgical technique known as a "Roux en Y," named after the Y-shaped configuration formed by the connecting loop of intestine. Robot-assisted surgery is ideally suited to this procedure, since the da Vinci Si's excellent visualization and suturing capabilities facilitate the surgeon's ability to perform the delicate and complex task of resecting and then surgically reconnecting different portions of the intestinal tract (a process called anastomosis).

Robotic Biliary Reconstruction at NYULMC

The GI/hepatobiliary surgical oncologists at NYU Langone Medical Center are among the first in the New York area to use the da Vinci robot for these applications, and are developing a comprehensive minimally-invasive and robotic program to treat all gastrointestinal (GI) cancers.

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