Robotic-assisted Common Bile Duct Exploration

Raquel G. Heredia, MD, PhD, Mario Masrur, MD, Melissa Murphey DNP. NP-C., Lisa Sanchez-Johnsen PhD., Enrique F Elli, MD, FACS. UIC

Common bile duct exploration is indicated in symptomatic patients with choledocholithiasis refractory to endoscopic therapy (ERCP)
Robotic approach may offer some advantages in complex cases.

Material and Methods:
This is a 77-year-old lady who was referred by the GI service with a history of right upper quadrant pain. Ultrasound showed multiple stones in the common bile duct (CBD). She underwent various ERCPs which were unable to remove the stones. A stent was left in the CBD. The patient was offered a robot-assisted cholecystectomy and common bile duct exploration

The procedure started with dissection at the calot triangle and the gallbladder.
The fluorescein cholangiography showed the bifurcation of hepatic ducts and CBD was dilated. The common bile duct was opened longitudinally in the anterior aspect. The common bile duct was explored and 5 large stones were removed. The previous stent was left in place.
Decision was made to perform a primary closure of the common bile duct with interrupted 4-0 PDS sutures.
Then, the cystic duct was clipped proximally and distally, as
well as the artery. Then, the gallbladder was removed from the gallbladder bed. Careful hemostasis was achieved on the liver bed. There were no intra- or post-operative complications. Patient was discharged POD 2.

This video highlights the technical details of a robotic common bile duct exploration. The robotic system allows for an accurate and fine dissection, with precise suturing. Choledochotomy might be consider as an alternative to hepaticojejunostomy in selective patients.

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