Jana DeJesus, Keenan Horani, Kush Brahmbhatt, Camila Franco Mesa, Sarah Samreen, Jennifer M Moffett
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As there is a paucity of literature evaluating the use of the robotic platform for CBDE, our study aims to compare intraoperative and post-operative outcomes between robotic-assisted one-stage and two-stage management of choledocholithiasis.</p><h3 data-test=\"abstract-sub-heading\">Methods</h3><p>A retrospective chart review was performed from May 1, 2022 to December 31, 2023, identifying patients with choledocholithiasis who underwent robot-assisted laparoscopic cholecystectomy and transcystic CBDE with choledochoscopy (one-stage management). Preoperative, intraoperative, and post-operative variables were compared to a control group of subjects with choledocholithiasis who underwent laparoscopic cholecystectomy with pre- or post-operative ERCP (two-stage management). Statistical analysis was performed using Chi-squared, Fisher’s exact, Student’s <i>T</i>, or Mann–Whitney test.</p><h3 data-test=\"abstract-sub-heading\">Results</h3><p>Fifty-three subjects who underwent one-stage management and 101 subjects who underwent two-stage management met inclusion criteria. Groups had similar demographics and medical history. Time to CBD clearance (45.2 h vs 47.0 h, <i>p</i> = .036), total length of stay (3.9 days vs 5.1 days, <i>p</i> = .007), fluoroscopy time (70.3 s vs 151.4 s, <i>p</i> < .001), and estimated radiation dose (23.0 mSv vs 40.3 mSv, <i>p</i> = .002) were significantly lower in the one-stage group compared to two-stage. Clearance rates, complication rates, and 30-day readmission rates were similar for both groups. Total length of stay and radiation exposure remained significantly lower on subanalysis comparing one-stage management to two-stage management with ERCP either before or after cholecystectomy.</p><h3 data-test=\"abstract-sub-heading\">Conclusion</h3><p>Robotic-assisted laparoscopic cholecystectomy with transcystic common bile duct exploration via choledochoscopy is a safe and feasible option in the management of choledocholithiasis. 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引用次数: 0
摘要
导言鉴于外科医生在处理胆总管结石时对回收胆总管的兴趣与日俱增，实施胆总管探查术（CBDE）的呼声日益高涨。胆总管探查术与胆囊切除术同时进行的优点包括减少麻醉事件和缩短住院时间。由于评估使用机器人平台进行 CBDE 的文献较少，我们的研究旨在比较机器人辅助胆总管结石一期和二期手术的术中和术后效果。方法 对 2022 年 5 月 1 日至 2023 年 12 月 31 日期间接受机器人辅助腹腔镜胆囊切除术和胆道镜经胆囊 CBDE（一期治疗）的胆总管结石患者进行回顾性病历审查。将术前、术中和术后变量与接受腹腔镜胆囊切除术和术前或术后 ERCP（两阶段管理）的胆总管结石对照组进行比较。统计分析采用Chi-squared、Fisher's exact、Student's T或Mann-Whitney检验。两组患者的人口统计学和病史相似。CBD 清除时间（45.2 h vs 47.0 h，p = .036）、住院总时间（3.9 天 vs 5.1 天，p = .007）、透视时间（70.3 s vs 151.4 s，p <.001）和估计辐射剂量（23.0 mSv vs 40.3 mSv，p = .002）在一期组明显低于二期组。两组的清除率、并发症发生率和30天再入院率相似。结论机器人辅助腹腔镜胆囊切除术并通过胆道镜进行经胆囊总胆管探查是治疗胆总管结石安全可行的选择。与两阶段治疗相比，它能缩短管道清理时间，缩短住院时间，减少辐射暴露。 图文摘要
Conquering the common bile duct: outcomes in minimally invasive transcystic common bile duct exploration versus ERCP
Introduction
Given the increasing interest for surgeons to reclaim the common bile duct in managing choledocholithiasis, there is a growing movement to perform common bile duct exploration (CBDE). Advantages of concomitant CBDE with cholecystectomy include fewer anesthetic events and decreased length of stay. As there is a paucity of literature evaluating the use of the robotic platform for CBDE, our study aims to compare intraoperative and post-operative outcomes between robotic-assisted one-stage and two-stage management of choledocholithiasis.
Methods
A retrospective chart review was performed from May 1, 2022 to December 31, 2023, identifying patients with choledocholithiasis who underwent robot-assisted laparoscopic cholecystectomy and transcystic CBDE with choledochoscopy (one-stage management). Preoperative, intraoperative, and post-operative variables were compared to a control group of subjects with choledocholithiasis who underwent laparoscopic cholecystectomy with pre- or post-operative ERCP (two-stage management). Statistical analysis was performed using Chi-squared, Fisher’s exact, Student’s T, or Mann–Whitney test.
Results
Fifty-three subjects who underwent one-stage management and 101 subjects who underwent two-stage management met inclusion criteria. Groups had similar demographics and medical history. Time to CBD clearance (45.2 h vs 47.0 h, p = .036), total length of stay (3.9 days vs 5.1 days, p = .007), fluoroscopy time (70.3 s vs 151.4 s, p < .001), and estimated radiation dose (23.0 mSv vs 40.3 mSv, p = .002) were significantly lower in the one-stage group compared to two-stage. Clearance rates, complication rates, and 30-day readmission rates were similar for both groups. Total length of stay and radiation exposure remained significantly lower on subanalysis comparing one-stage management to two-stage management with ERCP either before or after cholecystectomy.
Conclusion
Robotic-assisted laparoscopic cholecystectomy with transcystic common bile duct exploration via choledochoscopy is a safe and feasible option in the management of choledocholithiasis. It offers a shorter time to duct clearance, shorter length of stay, and less radiation exposure when compared to two-stage management.
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