Related Experiment Video
Updated: Aug 1, 2025
Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst
Published on: June 24, 2022
Robot-assisted and fluorescence-guided remnant-cholecystectomy: a prospective dual-center cohort study
Anton F Gijsen1, Harry G M Vaassen2, Alexander L Vahrmeijer3
1Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands, Koningsstraat 1, Po-Box 50000, 7500 KA, Enschede, the Netherlands; Department of General and Visceral Surgery, University Medical Centre Oldenburg, Oldenburg, Germany, Rahel-Straus-Straβe 10, 26133 Oldenburg, Germany.
Background:
Abdominal symptoms after cholecystectomy may be caused by gallstones in a remnant gallbladder or a long cystic duct stump. Resection of a remnant gallbladder or cystic duct stump is associated with an increased risk of conversion and bile duct or vascular injuries. We prospectively investigated the additional value of robotic assistance and fluorescent bile duct illumination in redo biliary surgery.
Methods:
In this prospective two-centre observational cohort study, 28 patients were included with an indication for redo biliary surgery because of remnant stones in a remnant gallbladder or long cystic duct stump. Surgery was performed with the da Vinci X® and Xi® robotic system. The biliary tract was visualised in the fluorescence Firefly® mode shortly after intravenous injection of indocyanine green.
Results:
There were no conversions or perioperative complications, especially no vascular or bile duct injuries. Fluorescence-based illumination of the extrahepatic bile ducts was successful in all cases. Symptoms were resolved in 27 of 28 patients. Ten patients were treated in day care and 13 patients were discharged the day after surgery.
Conclusion:
Robot-assisted fluorescence-guided surgery for remnant gallbladder or cystic duct stump resection is safe, effective and can be done in day-care setting.
