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. 2024 Oct 1;110(10):6418-6425.
doi: 10.1097/JS9.0000000000001817.

Robotic assisted common bile duct exploration for management of complex gallstone disease

Javed Latif  1 , Poppy Mountjoy  1 , Harrison Lewis  2 , Imran Bhatti  1 , Altaf Awan  1
Affiliations

Robotic assisted common bile duct exploration for management of complex gallstone disease

Javed Latif et al. Int J Surg. .

Abstract

Background: Minimally invasive cholecystectomy and common bile duct exploration offers single-stage management for complex gallstone disease (cholelithiasis and choledocholithiasis). The Robotic platform presents benefits in improving operative precision, which has not been extensively evaluated in the acute setting of managing complex gallstone disease, as well as in performing transcholedochal or postcholecystectomy common bile duct exploration. The authors report an early series of emergent and expedited robotic-assisted cholecystectomy with common bile duct exploration (RC-CBDE) or robotic common bile duct exploration (R-CBDE) alone.

Material and methods: A retrospective analysis from a specialist unit in the United Kingdom was undertaken from April 2022 to September 2023, inclusive. All patients who underwent RC-CBDE or R-CBDE were included. Data was collated on patient demographics, perioperative investigations, intraoperative approach, and postoperative outcomes.

Results: Twenty-three consecutive patients were identified. The median (IQR) age was 51 (33-66) years. Median (IQR) Charlson Comorbidity Index (CCI) was 1 (0-4). Five patients underwent operative intervention as an emergency and 18 on an expedited basis. Two patients underwent postcholecystectomy R-CBDE. Fourteen (61%) were transcholedochal and nine were transcystic (39%) CBDE. Median (IQR) bilirubin was 51 (34-253). Median (IQR) operative time was 176 (124-222) minutes. Median (IQR) postoperative length of stay was 2 (0-4) days. There were no bile leaks requiring intervention. The clearance rate of CBDS was 100%. No patients developed postoperative pancreatitis. One patient required intervention for port site hernia following RC-CBDE. One patient developed subhepatic collection postoperatively and required laparoscopic washout and placement of drains. No patients had retained stones after a 3-month follow-up.

Conclusion: Early experience confirms that RC-CBDE and R-CBDE in feasible, safe, and effective treatment for complex gallstone disease. Integrated adjuncts (intraoperative robotic ultrasound - IORUS and Firefly - fluorescence guided surgery - FGS) and superior ergonomics of the robotic platform may assist in reducing the learning curve and increase wider uptake of this complex procedure.

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Conflict of interest statement

Altaf Awan is a proctor for intuitive surgical.

Figures

Figure 1
Figure 1
Port placement for robotic cholecystectomy and common bile duct exploration.
Figure 2
Figure 2
Intraoperative robotic ultrasound demonstrating common bile duct (CBD), hepatic artery and portal vein.
Figure 3
Figure 3
A - Intraoperative image of common bile duct without Firefly mode. B–Intraoperative image of common bile duct fluorescence with Firefly mode.
See this image and copyright information in PMC

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