Intraoperative Video Consultation Following Bile Duct Transection Facilitates Direct OR Transfer for Robotic Hepaticojejunostomy at Tertiary Center

Bile duct injuries during cholecystectomy are most frequently attributed to misidentification of surgical anatomy. Initial management following a major bile duct injury is time-sensitive and critical to the patient's clinical course and overall outcome. We present a 63-year-old male patient who sustained a common bile duct transection during laparoscopic cholecystectomy at a resource-limited rural surgery center. Upon recognition of the injury, an intraoperative video consultation was made to hepatobiliary surgery at our academic referral institution, providing a real-time explanation of the dissection with direct visualization of surgical anatomy. This expedited sequence facilitated acquisition of diagnostic studies, including an intraoperative cholangiogram, confirming common bile duct transection, and a CT angiogram, demonstrating intact arterial anatomy. Direct to OR transfer to the tertiary facility was therefore prioritized, circumventing a prolonged bed wait the patient would have otherwise required while awaiting injury diagnosis and characterization. He underwent definitive repair with robotic-assisted Roux-en-Y hepaticojejunostomy on the same day that the injury occurred. This paper provides an operative video with a concise and adoptable method for performing a definitive hepaticojejunostomy following bile duct transection intended for fellowship-trained hepatobiliary surgeons.