How I Do It: Simplified Transcystic Antegrade-only Robotic Common Bile Duct Exploration (RCBDE).

IF 1.1 4区医学 Q3 SURGERY

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Pub Date : 2024-11-22 DOI:10.1097/SLE.0000000000001339

Eleah D Porter, Michael Carge, Heather O'Field, Mohamed Kelli, Sarah E Johnson, Ralph Wesley Vosburg, Byron Fernando Santos

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引用次数: 0

Abstract

Background: Data consistently supports a surgery-first approach to common bile duct (CBD) stones in patients with a gallbladder via laparoscopic CBD exploration (LCBDE). LCBDE has equivalent efficacy and decreased cost as compared with cholecystectomy plus endoscopic retrograde cholangiopancreatography (ERCP). However, adoption has been low due to the technical limitations of laparoscopy. We describe a straightforward and highly reproducible robotic CBDE (RBCDE) technique.

Methods: A cystic ductotomy is made after obtaining a critical view of safety. Through a 5 mm port, a wire-ready cholangiogram catheter is secured in the cystic duct and intraoperative cholangiogram performed. Based on stone burden, small versus large, either an antegrade balloon snowplow (push stones forward) or sphincteroplasty is performed over a wire under fluoroscopy. If concern persists for retained stones, choledochoscopy is performed.

Conclusions: Our simplified antegrade-only RCBDE technique allows surgeons to consistently offer a surgery-first, single-stage approach to CBD stones in patients with a gallbladder.

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我是怎么做的：简化经囊前单纯机器人胆总管探查术（RCBDE）。

背景：数据一致支持通过腹腔镜胆总管探查术（LCBDE）先行手术治疗胆囊患者的胆总管（CBD）结石。与胆囊切除术加内镜逆行胰胆管造影术（ERCP）相比，腹腔镜胆总管探查术（LCBDE）具有同等疗效，且费用更低。然而，由于腹腔镜技术的局限性，其采用率一直很低。我们介绍了一种简单、可重复性高的机器人 CBDE（RBCDE）技术：方法：在获得安全的关键视野后，进行胆囊导管切开术。通过一个 5 毫米的孔，在胆囊管内固定一根可接线的胆管造影导管，并进行术中胆管造影。根据结石的大小，在透视下通过导线进行前向球囊扫除（将结石推向前方）或括约肌成形术。如果仍然担心结石残留，则进行胆道镜检查：结论：我们简化的仅前向降结石的 RCBDE 技术使外科医生能够始终如一地为胆囊结石患者提供手术先行、单阶段的 CBD 结石治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 医学-外科

CiteScore

2.00

自引率

10.00%

发文量

103

审稿时长

3-8 weeks

期刊介绍： Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.