560 Management of severe haemorrhage during pediatric robotic hepatico-jejunostomy

Dr. Ankur Mandelia

Aberrations in biliary ductal and vascular anatomy are common and pose major challenges during minimally invasive pediatric surgery. In robotic choledochal cyst (CDC) excision with hepatico-jejunostomy (HJ), unexpected bleeding from aberrant vessels can rapidly obscure vision, complicate dissection, and threaten patient safety. Two boys (18 and 24 months) underwent robotic CDC excision with HJ. Both patients had vascular aberrations, leading to unexpected arterial bleeding during dissection from an unidentified accessory cystic artery coursing along the right margin of common hepatic duct (CHD). Bleeding was controlled robotically in both cases without conversion or blood transfusion. The remainder of the procedure was completed uneventfully in both cases, and the patients recovered well. The innovation lies in leveraging the robotic platform’s stability, three-arm control, and high-definition vision to manage severe intraoperative bleeding. This demonstrates that robotic surgery, in experienced hands, not only facilitates complex reconstruction but also enhances safety in crisis situations. Pediatric Surgery, Procedure Innovation

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