A case of subserosal bile infiltration due to gallbladder injury during robot-assisted nephrectomy (with video)

With the spread of minimally invasive surgery (MIS), various MIS-specific iatrogenic complications have been reported; however, subserosal bile infiltration of the gallbladder has not been documented. We report a case of subserosal bile infiltration occurring during robot-assisted radical right nephrectomy for clear cell renal carcinoma after robot-assisted partial nephrectomy. Following right kidney resection, dark green discoloration of the gallbladder was observed. Reviewing the operative video revealed that the color change developed during retraction with a snake retractor. Although no bile spillage was observed, laparoscopic cholecystectomy was performed because gallbladder injury was suspected. During dissection from the gallbladder bed, bile was observed within the subserosal layer, confirming subserosal bile infiltration. Subserosal bile infiltration is a rare form of gallbladder injury; however, it may progress to bile peritonitis and should be recognized as a potential complication requiring careful attention during surgery.