Dr. Iswanto Sucandy: A Specialist in Robotic Bile Duct Repair. Find Out More

Bile duct leak can be caused by many reasons, such as an accidental bile duct injury during a problematic laparoscopic cholecystectomy, abdominal trauma (stab or gunshot wound), or a large gallstone impinging on the bile duct wall causing a pressure necrosis phenomenon (called Mirizzi syndrome). However, the most common reason for bile duct leak is iatrogenic laparoscopic cholecystectomy. In such situations, robotic bile duct repair is the safest and minimally invasive surgery available.

Biliary surgery is a highly specialized procedure, which requires training and experience. Most general surgeons and community hospitals do not have adequate technical expertise in biliary surgery. Biliary tract anatomy can vary among patients, and recognition of this anomaly is crucial in undertaking bile duct surgery. Liver surgeons gained an understanding of subsegmental biliary anatomy from performing bile duct resection for cancer (Klatskin tumor resection). Accessory branches from perihilar liver segments can be found without warnings, and they can be easily injured when not carefully identified.

High volume Tampa Liver surgery centers often become the destination center (referral center) for any biliary problems (leak, trauma, obstruction, stricture, and cancer) due to the availability of multidisciplinary expertise. Interventional radiologists and advanced endoscopists are parts of the multidisciplinary team treating bile duct leaks. In Tampa Bay Area, we have become the referral center for biliary diseases/biliary surgery. We routinely treat patients with bile duct injury during a laparoscopic cholecystectomy from the surrounding areas. Many of them were recognized during the gallbladder removal surgery, but a significant percentage of bile duct injuries were identified several days following the gallbladder surgery. Patients usually develop fever, abdominal pain, nausea/vomiting, jaundice (yellowing of skin and eyes), or failure to thrive from the bile duct leak. Whenever possible, bile duct leak/injury is managed non-operatively using an endoscopic biliary stent placement or via a percutaneous transhepatic approach. For certain types of bile duct leak/injury, such as its complete transection, a bile duct reconstruction surgery or a bile duct replacement surgery is necessary from the index diagnosis.

Go for Minimally Invasive Procedures for Bile Duct Resection for Safer Outcomes

The majority of biliary surgeries for any reason are still performed with the traditional open operation. Only a few Tampa Liver surgery centers in the United States have adequate expertise in minimally invasive bile duct resection. Whenever technically feasible, minimally invasive bile duct repair (laparoscopic or robotic) is preferable due to the lower rate of postoperative complications, less pain, shorter recovery, and earlier return to work. Robotic surgery facilitates highly precise dissection around the bile ducts, portal vein, and hepatic artery. Robotic bile duct repair surgery also enables a delicate suturing of the bile ducts to avoid postoperative bile leaks or biliary fistula. Compared to the conventional laparoscopic method, the robotic bile duct leak repair operation leads to better outcomes. A closed suction drain is routinely placed for all bile duct repairs. This is removed at a later time prior to hospital discharge or in the office during the first follow-up visit.

Dr. Iswanto Sucandy and his Tampa Liver surgery team is the referral destination for bile duct leak/injury following laparoscopic cholecystectomy in Tampa Bay Area, in addition to other bile duct resections for cancer. Dr. Iswanto Sucandy has significant expertise in minimally invasive robotic bile duct repair/reconstruction. Long-term patency of the biliary system greatly depends on the experience/expertise of the liver surgeon or bile duct surgeon. High-volume centers produce superior/better outcomes when compared to low-volume centers. This fact has been well documented in the surgical literature, similar to other complex liver and pancreas operations. In the past several years, our team had presented methods and outcomes of robotic bile duct repair at several national academic surgical meetings.