Robotic Common Bile Duct Exploration for Choledocholithiasis.

Abstract

Background and objectives: Robotic surgery has facilitated minimally invasive surgery with its enhanced visualization and improved dexterity compared to open and laparoscopic approaches. However, widespread adoption remains limited by steep learning curves. We describe procedural steps, technical considerations, and early clinical outcomes with a 1-stage robotic-assisted cholecystectomy with common bile duct exploration.

Methods: A single-institution case series of 21 patients undergoing robotic-assisted cholecystectomy with common bile duct exploration from October 2022 to August 2024 was retrospectively reviewed.

Results: Nine patients were female (43%), and the median age was 70 (interquartile range [IQR] 64-76). No patient required conversion to laparotomy or laparoscopy. Two patients (10%) required postoperative endoscopic retrograde cholangiopancreatography for duct clearance. The median total operative time was 215 minutes (IQR 180-290). The median fluoroscopy time was 1.5 minutes (IQR 1.2-2.1). We review the bed orientation, overall room set up, and robot arms rearrangements that were required to accommodate the C-arm for intraoperative fluoroscopy.

Conclusion: Robotic-assisted cholecystectomy with common bile duct exploration is possible but requires dedicated equipment and staff arrangements. Engagement of hospital staff including surgeons, anesthesiologists, radiology technicians, operating room nurses, and surgical technologists are paramount for success.