Related Experiment Video
Updated: Jun 9, 2026
Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
Experience with robotic common bile duct exploration for common bile duct stones in comparison to a conventional
M J Carvill1, M A Glaysher1, P H Pucher1,2
1Department of Upper GI Surgery, Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO63LY, UK.
Introduction:
Common bile duct (CBD) stones are present in up to 20% of patients with gallstones and are associated with complications such as obstructive jaundice, cholangitis, and pancreatitis. Current guidelines support both endoscopic and surgical CBD stone extraction. While laparoscopic common bile duct exploration is an established technique, evidence on robotic CBD exploration remains limited.
Methods:
A retrospective cohort study was conducted, including all adult patients who underwent CBD exploration between January 2020 and December 2024. Demographic, operative, and outcome data were collected and compared between patients undergoing laparoscopic versus robot-assisted CBD exploration.
Results:
A total of 313 CBD explorations were performed: 274 laparoscopic and 39 robotic. Baseline characteristics were comparable between groups. Most procedures were performed acutely (laparoscopic 83.2% vs robotic 56.4%, p = 0.002). Mean operative duration was 134 minutes in both groups. Conversion to open surgery occurred in three laparoscopic cases; no robotic cases required conversion. Intra-operative ultrasound was used more frequently in robotic cases (76.9% vs 18.5%, p < 0.001) whilst intra-operative cholangiography was more common in laparoscopic procedures. Median hospital stay was 2 days in both groups. Overall complication rates were similar (laparoscopic 14.2% vs robotic 15.4%, p = 0.916). No statistical differences were noted in Clavien-Dindo complication grades between groups.
Discussion:
This single-centre analysis demonstrates that robot-assisted CBD exploration is safe and yields comparable intra-operative and postoperative outcomes to laparoscopic exploration. Despite a potential learning curve, varying robotic availability in emergency settings, and overall lower rate of robotic procedures compared to conventional laparoscopy, the study supports robotic CBDE as a viable and non-inferior approach to laparoscopic CBDE. Further prospective multicentre studies and economic evaluations are warranted to define best practices and establish a robotic pathway for CBD exploration, particularly in the emergency setting.
