Minimally invasive surgery for post cholecystectomy biliary stricture: current evidence and future perspectives

Figure 1 Adhesiolysis and initial dissection phase. A: Perihepatic adhesions are left undisturbed to facilitate liver retraction and exposure of the hilum; B: Dissection proceeds towards the umbilical fissure with careful identification and preservation of the left hepatic artery (arrow).

Figure 2 Identification of hepatic duct. A: Internal fistula between the hepatic duct and duodenum (arrow); B: Division of the fistula facilitates visualization of the hepatic duct (arrow).

Figure 3 Lowering the hilar plate. A: Indocyanine green fluorescence facilitates hepatic duct identification; B: Hilar plate lowered by dissection between the Glissonean sheath and Laennec’s capsule.

Figure 4 Opening the hepatic duct. A: Identification and opening of the left hepatic duct; B: Confluence of left hepatic duct with right hepatic duct identified.

Figure 5 Roux-en-Y hepaticojejunostomy. A: Roux limb of jejunum taken to the supracolic compartment through the mesocolic window; B: Completed hepaticojejunostomy.