Robot Assisted Management of Complex Choledocholithiasis Using Holimum Laser

Omaira Rodriguez, MD, Renata Sanchez, MD, Luis Medina, MD, Oriana Salamo, MD, Valentina Baez, MD, Alexis Sanchez, MD, MSc. Robotic Surgery Program – University Hospital Of Caracas, Robotic And Minimally Invasive Surgery Center – La Floresta Medical Institute.

The holmium laser is a useful tool in the management of complex choledocholithiasis. It allows safe and effective fragmentation of intrahepatic or impacted stones. We describe our technique using laser in Robot Assisted laparoscopic common bile duct exploration (LCBDE) with the Da Vinci® system. The robot assisted procedure provides certain benefits related to optimal visión and EndoWrist instruments.

Case presentation of a 42 years old male patient with diagnosis of choledocholithiasis unsolved by endoscopic approach. We perform a Robot Assisted LCBDE using choledochoscope and holmium laser to achieve stone fragmentation and extraction.

Robot Assisted LCBDE was performed using a choledochoscope demostrating a large impacted stone. The stone fragmentation was achieve using holmium laser and extracting the residuals with an helicoidal basket. We performed primary closure of the bile duct with separate 4-0 Vicryl stitches. Docking time was 12 minutes and console time 118 minutes. The patient progresses satisfactorily and was discharge 48 hours postop without complications.

Robot Assisted laparoscopic common bile duct exploration using Holmium Laser is a feasible procedure that would increase the success rate in cases of complex choledocholithiasis.

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