Laparoscopic choledochal cyst resection using a novel articulating instrument in pediatric patients

Abstract

Historically, choledochal cyst excision has been performed as an open procedure. Controversy remains regarding managing this technically challenging entity in a minimally invasive fashion. A novel mechanically-designed intuitive, articulating instrument is used to facilitate intracorporeal suturing when there is limited working space. The mechanical design of the three-axis Gimbal cuff facilitates intracorporeal suturing by providing intuitive wristed function to the surgeon by translating the surgeon's wrist movement to the end effector. We describe the adoption of a novel articulating instrument to facilitate a primary hepaticoduodenostomy within the limited space of a pediatric porta and a redo hepaticojejunostomy. These cases demonstrate the use of a novel articulating needle driver to sew an intracorporeal bilio-enteric anastomosis which obviates the need for robotic technology while expanding a laparoscopic surgeon's armamentarium.