Robotic Assisted Laparoscopy Enables High-Risk Biliary Surgery

John C LaMattina, MD, Benjamin Philosophe, MD, PhD, Mark D Kligman, MD, Rolf N Barth, MD

University of Maryland School of Medicine

Laparoscopic surgery has been demonstrated to reduce the morbidity of surgery in high-risk patients. We postulated that use of robotic platforms would allow for high rates of success in high-risk cirrhotic patients or for complicated hepatobiliary procedures.

Eleven patients underwent robotic assisted laparoscopic surgery for either cholecystectomy (n=8) or hepaticojejunostomy (n=2) after bile duct injury over a 5 month period. Cholecystectomy was performed in 4 patients with advanced cirrhosis and 2 patients with Mirizzi syndrome. Patient outcomes were measured as success in completion of procedure, conversion to open surgery, morbidity, and mortality.

All eleven patients successfully completed the robotic assisted laparoscopic surgery without conversion to open surgery or early termination of the robotic procedure. Hepaticojejunostomy required manual laparoscopic creation of Roux limb with conversion to robotic biliary anastomoses. Both patients who had hepaticojejunostomy had transient bile leak that resolved without further intervention. Cirrhotic patients had presence of ascites, portal hypertension, and significant portal varices. All laparoscopic cholecystectomy patients were either discharged or received liver transplantation. No 30-day patient mortality was observed and no patients required re-operation.

Robotic assisted laparoscopy enabled high-risk surgery with few complications. The ability to complete high-risk surgery with robotic assisted laparoscopic techniques benefitted patients in terms of reduced morbidity and mortality. Further application of robotic assisted laparoscopic techniques may be most beneficial in high-risk patients.

Session: Poster Presentation

Program Number: P351

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