William B Lyman, MD, Michael Passeri, MD, David A Iannitti, MD, FACS, Dionisios Vrochides, MD, PhD, FACS, FRCSC, Erin H Baker, MD, FACS, John B Martinie, MD, FACS. Carolinas Medical Center
Background: Housed in a high volume tertiary referral center, our division receives a large amount of transfers and referrals from outside institutions for patients who require completion cholecystectomies. In this study “completion cholecystectomy” refers to patients that meet one of three criteria: 1. previous subtotal cholecystectomy, 2. previously aborted cholecystectomy, or 3. previous cholecystectomy with incidental finding of cancer on pathology. Traditionally, exploration of a reoperative field in the right-upper quadrant mandates an open approach due to dense adhesions and inflammation. Over the past few years, we have found that robotic-assisted surgery has allowed us to perform these completion cholecystectomies in a minimally invasive fashion.
Methods: Case logs and operating room billing logs were reviewed from 2010 to 2017 to identify all robotic-assisted cholecystectomies performed at our institution. Review of all reports identified 30 completion cholecystectomies. All additional variables including demographics, operative variables, and postoperative outcomes were determined from manual chart review of all consultation notes, operative reports, anesthesia records, progress notes, discharge summaries, and postoperative office visits.
Results: Of the 30 identified robotic-assisted completion cholecystectomies, 16 patients had a previous subtotal cholecystectomy, 11 patients had an aborted cholecystectomy, and 3 patients had an incidental finding of T2 gallbladder carcinoma on pathology. Fifteen patients (50%) underwent preoperative ERCP either for choledocolithiasis or to determine biliary anatomy. Average time from original procedure was 44 months with 30.0% of previous procedures performed in an open approach. Average OR time was 142.1 minutes, average EBL was 102.1cc, and average length of stay was 2.1 days. One patient (3.3%) was readmitted within 30 days for nausea that resolved with antiemetics. Three patients (10.0%) had minor postoperative complications (Clavien-Dindo grade 1 or 2) which resolved with pharmacologic therapy. No patients suffered a 90-day mortality. All cases were completed in minimally invasive fashion without a conversion to an open procedure.
Conclusions: Although rare, completion cholecystectomies present a challenging surgical scenario. Although traditionally performed in an open approach, we have had success in recent years at our institution with a robotic-assisted approach to completion cholecystectomy. We feel that the robotic approach offers certain advantages in a hostile, reoperative field which allows us to perform these procedures in a minimally invasive fashion with no conversions to an open procedure to date. Previously limited to case reports, this report of 30 procedures represents the largest case series of robot-assisted completion cholecystectomies to our knowledge.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87850
Program Number: P080
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster