Robot-assisted versus laparoscopic common bile duct exploration: impact of hilar adhesions
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Updated: Oct 31, 2026
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Long Huang1,2, Dihang Wu1,2, Jianlin Lai1,2
1Shengli Clinical Medical College of Fujian Medical University, No. 134 East Street, Fuzhou, 350001, China.
Background:
Laparoscopic common bile duct exploration (LCBDE) is an established treatment for common bile duct (CBD) stones, but laparoscopic choledochotomy and CBD suturing remain technically demanding. Robot-assisted common bile duct exploration (RCBDE) may overcome some limitations of conventional laparoscopy. This study evaluated the safety and feasibility of RCBDE using a novel "lightning" port placement technique and compared its perioperative outcomes with those of LCBDE.
Methods:
This retrospective study included patients who underwent RCBDE or LCBDE for CBD stones at Fuzhou University Affiliated Provincial Hospital between January 2023 and June 2025. Patients with a preoperative stone diameter ≥ 1.0 cm were included. Patients who underwent preoperative percutaneous transhepatic cholangial drainage were treated surgically 1 month after resolution of inflammation, improvement of liver function, and stabilization of general condition. Propensity score matching was performed at a 1:1 ratio. Perioperative outcomes, postoperative recovery, hospitalization cost, and outcomes stratified by hilar adhesions were analyzed.
Results:
A total of 331 patients were included, comprising 107 in the RCBDE group and 224 in the LCBDE group. After matching, 106 matched pairs were obtained. Compared with LCBDE, RCBDE was associated with shorter CBD suturing time, less intraoperative blood loss, lower bowel injury rate, reduced additional trocar placement, and lower conversion-to-open rate. Postoperatively, RCBDE resulted in fewer overall complications, reduced bile leakage after matching, faster bowel recovery, shorter drainage duration, and shorter postoperative hospital stay, although total hospitalization cost was higher. Hilar adhesions were independently associated with postoperative complications and bowel injury, while favorable outcomes with RCBDE were observed in this subgroup.
Conclusions:
RCBDE was safe and feasible for CBD stones and was associated with favorable perioperative outcomes compared with LCBDE. Hilar adhesions were associated with greater operative complexity and perioperative risk.
