How I Do It: Robotic Choledochoscopy

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Surgical Technology

Background:

• Robotic surgery adoption is increasing among general surgeons, leading to more robotic cholecystectomies.
• Intraoperative cholangiography is crucial for diagnosing choledocholithiasis.
• This study details a technique for robotic intraoperative cholangiograms with choledochoscopy.

Purpose of the Study:

• To describe a technique for performing robotic intraoperative cholangiograms and transcystic common bile duct exploration.
• To highlight the efficiency benefits of a no-undocking approach.

Main Methods:

• Preoperative cholangiogram decision based on clinical findings.
• Robotic platform used with all arms docked for the procedure.
• Ductotomy, cholangiocatheter insertion, and cholangiogram imaging.
• Robotic transcystic common bile duct exploration with SpyGlass Discover digital if stones are present.
• Gallbladder removal and overnight patient observation.

Main Results:

• The described technique allows for robotic intraoperative cholangiograms and choledochoscopy without undocking.
• Choledocholithiasis can be managed effectively using this robotic approach.
• Patients are typically discharged on postoperative day 1.

Conclusions:

• Robotic transcystic common bile duct exploration is a safe and reproducible method for treating choledocholithiasis.
• The described technique offers improved efficiency by avoiding robotic undocking.