Robotic-assisted approach for complex cholecystectomies

Area of Science:

• Minimally Invasive Surgery
• Surgical Robotics
• Gastrointestinal Surgery

Background:

• Complex benign gallbladder disease presents significant surgical challenges.
• Traditional laparoscopic techniques may be limited in managing these difficult cases.
• Robotic platforms offer enhanced dexterity and visualization for complex procedures.

Purpose of the Study:

• To describe the technical advantages and management principles of robotic-assisted laparoscopic (RAL) cholecystectomy for complex gallbladder disease.
• To share lessons learned from four challenging cases managed with RAL approach.
• To encourage the adoption of robotic surgery for complex gallbladder pathologies.

Main Methods:

• Retrospective review of four complex cholecystectomy cases managed with robotic assistance.
• Utilized wristed instruments, 3D camera, indocyanine green (ICG) with fluorescent imaging, and intracorporeal suturing.
• Detailed description of surgical techniques for subtotal reconstituting, subtotal fenestrating, cholecystocolonic fistula, and cholecystoduodenal fistula cases.

Main Results:

• All four complex cholecystectomies were performed safely using the RAL approach without intraoperative injury or conversion to open surgery.
• Three out of four patients were discharged from the recovery room.
• Favorable outcomes were attributed to the capabilities of the robotic platform.

Conclusions:

• Robotic-assisted laparoscopic surgery provides significant advantages for managing complex benign gallbladder disease.
• The platform's features facilitate safe and effective minimally invasive treatment of challenging gallbladder pathologies.
• Sharing these adaptations can guide experienced robotic surgeons in tackling complex cases.