Robotic‐assisted repair of iatrogenic common bile duct injury after laparoscopic cholecystectomy: Surgical technique and outcomes

Abstract

BackgroundBile duct injury after cholecystectomy can be a life‐threatening complication. Use of robotic approach to manage a complex biliary injury is in an early phase.MethodsWe have performed an analysis of our prospectively maintained database that included 12 patients who underwent robotic‐assisted repair of bile duct injury after laparoscopic cholecystectomy between 2014 and 2017.ResultsAll patients underwent robotic biliary repair within 2 weeks after primary injury. No conversion to open surgery was necessary, the estimated mean blood loss was 252 mL, and the mean operative time was 260 minutes. The mean length of stay was 9.4 days. The 30‐day complication events were a subhepatic abscess and a recurrent episode of cholangitis. One patient underwent the reoperation. The mortality was null.ConclusionRobotic‐assisted bile duct injury repair seems to be safe and feasible. It offers promising results, thus potentially capable of modifying the management of biliary injury.

2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy

“…Regardless of the technique used, tension-free bilioenteric anastomosis with good mucosal apposition and vascularized ducts is the mainstay of treatment [227]. Recently, robotic procedures have been suggested due to enhanced visualization, better tissue handling, and more precise surgery [228]. In the presence of increased tissue fragility, the expertise of the HPB surgeon in the tertiary care center is likely to improve the final results and consequently the long-term outcomes [194,195,229].…”

Minimally invasive surgery for the management of major bile duct injury due to cholecystectomy

“…Full texts were thus evaluated, including the relative references of each study. Finally, a total of 31 reports were included in the analysis . The PRISMA diagram is given in Figure .…”

“…Of these, 53 patients (45%) underwent conventional laparoscopic surgery, while 64 patients (55%) received surgery with the robot. As for surgical procedures, 109 patients (94%) were treated with standard Roux‐en‐Y hepaticojejunostomy (HJ), while eight patients received alternative procedures including Roux‐en‐Y choledochojejunostomy, left hemihepatectomy and HJ, Roux‐en‐Y bi‐HJ, the Kasai procedure, redo‐HJ, and HJ on a previous Roux‐en‐Y gastric bypass . The overall rate of conversion to an open procedure was <1%, ranging from 0 to 25% among studies.…”

“…Despite this, the application of MIS in the management of cholecystectomy‐related BDI has increased over recent years, with a number of experienced centers worldwide reporting promising results . However, general conclusions are difficult to draw, as the currently available data are mainly derived from studies of low‐level evidence reporting highly variable outcomes . Accordingly, the aim of our study was to pool the available evidence from the literature to define the actual role of MIS in the surgical repair of BDI due to cholecystectomy.…”

“…The present review aggregates the outcomes of patients receiving minimally invasive BDI repair along a period greater than 25 years. Interestingly, in the case of biliodigestive reconstruction the application of conventional laparoscopy accounts for less than half of procedures, while most surgeries have been undertaken with the robot only during the last 5 years . This reflects precisely the recent evolution of clinical practice in the setting of complex liver and pancreatic surgery, for which the robot is offering a valid option to facilitate and widen the range of applications of MIS, as compared with standard laparoscopy …”