561 Robotic Hepatico-jejunostomy for Choledochal Cyst with Type-VII Biliary Ductal Anomaly with the aid of ICG guided Fluorescence Imaging

Dr. Ankur Mandelia

Biliary ductal anatomical variations present a significant challenge in the minimally invasive management of choledochal cysts (CDC). Among these, Type VII variations are exceedingly rare and unclassified, complicating surgical planning and reconstruction. We report the case of a 6-year-old girl with recurrent pancreatitis and Type I fusiform CDC associated with a long pancreato-biliary malunion and aberrant low insertion of the right posterior sectoral duct (RPSD) into the distal common bile duct. The problem of safely identifying and reconstructing aberrant ducts was addressed using a robotic approach with the da Vinci Xi system, aided by indocyanine green (ICG) fluorescence imaging for real-time biliary mapping. Ductoplasty was performed to unify the common hepatic duct and RPSD into a single ostium, followed by a wide hepatico-jejunostomy. The innovation lies in combining robotic precision with fluorescence-guided anatomy delineation, enabling safe reconstruction in rare biliary variants. The patient recovered uneventfully with normal postoperative outcomes. Pediatric Surgery, Procedure Innovation

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