Robotic‐assisted completion cholecystectomy: A safe and effective approach to a challenging surgical scenario – A single center retrospective cohort study

Abstract

Background: Reoperation following a previous subtotal or aborted cholecystectomy presents a challenging surgical scenario that has traditionally required an open completion cholecystectomy. The aim of this study was to describe an institutional experience with a robotic-assisted approach to completion cholecystectomy. Methods:A database was retrospectively audited to identify all patients who underwent robotic-assisted cholecystectomy performed by two hepatopancreatobiliary surgeons at a single centre from 2010 to 2019. Results:Twenty six patients who underwent a robotic-assisted completion cholecystectomy were identified. Median operative time was 142 min (48-247 min) with a blood loss of 50 cc (0-500 cc). Minor complications (Clavien-Dindo ≤ II 90 days) occurred in three patients (11.5%) with no major complication or mortality reported. Median hospital length of stay was 1 day (0-6 days) with one patient readmitted. Conclusion:This study represents to our knowledge the largest series of roboticassisted completion cholecystectomies to date. The robotic approach appears to be a safe and effective procedure associated with a low morbidity and high success rate.

Robotic management of primary cholecystoduodenal fistula: A case report and brief literature review

“…One study by Tschuor et al reported robotic cholecystectomy in three patients with CDF but does not describe if or how the fistula was treated. 14 videos of intraoperative techniques were not reported in papers reporting robotic CDF closure. A summary of studies is shown in Table 1.…”

“…The advantages of robotic surgery are numerous and include ease of manoeuvring, camera and tool stability, 3D visualisation, better access to small spaces, and improved control 8,11 . Current studies show successful robotic management of bilioenteric fistulas and specifically robotic cholecystectomy with cholecystoduodenal fistula closure, with none of these needing to convert to an open approach 2,11–17 …”

“…8,11 Current studies show successful robotic management of bilioenteric fistulas and specifically robotic cholecystectomy with cholecystoduodenal fistula closure, with none of these needing to convert to an open approach. 2,[11][12][13][14][15][16][17] Our search of current literature reveals that cholecystoenteric fistulas remain a rare but important finding. Only a handful of papers discuss robotic management of any type of CEF; therefore, it is difficult to make conclusions on best practices and recommendations for patient management.…”

Robotic-assisted completion cholecystectomy with repair of cholecystoduodenal fistula

“…In a retrospective cohort study of 26 patients who underwent robotic-assisted completion cholecystectomy, the mean operative time was 142 min, and the median length of stay was 1 day with one readmission. Three patients experienced minor (Clavien-Dindo ≤ II) complications [ 7 ]. In a case series of robotic-assisted completion cholecystectomy, all three patients initially presented with gangrenous cholecystitis treated with subtotal cholecystectomy to avoid iatrogenic damage to the common bile duct.…”

Major iatrogenic bile duct injury during elective cholecystectomy: a Czech population register-based study

“…Though a majority of cholecystectomies are performed laparoscopically, a smaller proportion is performed openly. Hence, a new robot-assisted cholecystectomy program is currently being developed [1,2]. Laparoscopic cholecystectomy is a popular and routinely performed procedure in general abdominal surgery worldwide [3].…”