Surgical Endoscopy

, Volume 27, Issue 1, pp 263–266

Robot-assisted common bile duct exploration as an option for complex choledocholithiasis

  • Nawar A. Alkhamesi
  • Ward T. Davies
  • R. Fiona Pinto
  • Christopher M. Schlachta
Article

DOI: 10.1007/s00464-012-2431-0

Cite this article as:
Alkhamesi, N.A., Davies, W.T., Pinto, R.F. et al. Surg Endosc (2013) 27: 263. doi:10.1007/s00464-012-2431-0

Abstract

Background

This study aimed to describe the authors’ early experience with robot-assisted common bile duct exploration (CBDE) for choledocholithiasis refractory to endoscopic therapy and to compare the outcomes with those of equivalent patients undergoing an open technique.

Methods

At our institution, 55 CBDEs were performed between 2005 and 2010. All 19 robot-assisted cases were unselected elective referrals for stone disease. Of 36 open procedures, emergency cases and exploration not for stone disease were excluded, leaving 18 cases for analysis. Cases were analyzed on an intent-to-treat basis. A P value of 0.05 denoted statistical significance.

Results

The patients did not differ in terms of demography, comorbidity, or presenting symptoms. The reasons for endoscopic failure in both groups were similar. The mean operating time was longer for robot-assisted surgery (220 ± 41.26 min) than for open surgery (169 ± 65.81 min) (P = 0.01), but the median hospital stay was shorter (4 vs 11 days; P = 0.02). Four conversions to open surgery (21 %) were performed due to severe adhesions. The two groups did not differ statistically in terms of T-tube usage (74 vs 61 %; P = 0.414). One death occurred in the robotic group and two in the open cohort. Postoperative complications occurred in seven robotic and ten open cases (P = 0.402). They were mainly respiratory complications in the robot-assisted group, whereas they were cardiac and wound-related complications in the open group. Two of the converted cases had complications similar to those of the open group. Postoperative endoscopic retrograde cholangiopancreatography (ERCP) for retained stones was performed in one open case and three robotic cases.

Conclusion

Robot-assisted CBDE offers some benefit when ERCP fails. Ideal case selection may enhance success.

Keywords

Robotic-assisted surgeryCommon bile duct explorationCholecystectomyCholedocholithiasisCommon bile duct stonesMinimally invasive surgery

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Nawar A. Alkhamesi
    • 1
    • 2
  • Ward T. Davies
    • 1
    • 2
  • R. Fiona Pinto
    • 1
    • 2
  • Christopher M. Schlachta
    • 1
    • 2
  1. 1.CSTAR (Canadian Surgical Technologies & Advance Robotics)University Hospital, London Health Science CentreLondonCanada
  2. 2.Department of SurgerySchulich School of Medicine and Dentistry, The University of Western OntarioLondonCanada