From Localization to Navigation: Expanding the Role of Intraoperative Ultrasound in Robotic Surgery

Recurrent subphrenic abscess from retained radiolucent gallstones is a difficult problem: the stones are often difficult to localize due to its radiolucency, the operative field is confined and distorted due to its inflammation, and dissection lies close to the heart, pleura, and kidney. We report the case of a 77-year-old man with recurrent subphrenic abscesses, in whom these challenges were resolved with a robotic approach using a miniature drop-in ultrasound probe (FUJIFILM L51 K). The probe confirmed that a trans-diaphragmatic abscess and its contained stone lay deeper than the dissection plane suggested, defined a safe plane for de-roofing within 1 cm of the right atrium and pleura, and directed dissection of a second posterior collection between the inferior vena cava, pleura, and right kidney. All stones were retrieved without complication. The patient was discharged on day 5 and remained well at 20 months. This case illustrates the expanding role of advanced real-time imaging technologies in enhancing safety and precision in modern minimally invasive surgery.