Esposito S*, Daskalaki D, Gonzalez-Ciccarelli LF and Giulianotti PC
Department of Surgery, Division of General, Minimally Invasive, and Robotic Surgery, University of Illinois Hospital and Health Sciences System, USAFulltext PDF
Introduction: Conversion rates for Laparoscopic Cholecystectomy (LC) still range from 1.9% to 15 % and are higher when it comes to acute cholecystitis. Preoperative risk factors for conversion to open (CTO) technique are: previous upper abdominal surgery, male gender, age over 65, high BMI and history of acute cholecystitis treated conservatively. Besides that, the reported incidence of iatrogenic bile duct injuries varies between 0, 1% and 0, 5%.Case
Presentation: 67-year-old male with a history of previous laparoscopic distal splenopancreatectomy complicated by severe pancreatitis, infected pseudocyst and colonic fistula. During this complex postoperative course he also developed acute cholecystitis with suspicion of rupture and pericholecystic abscess treated with a cholecystostomy tube. Months later, still with the cholecystostomy in place, we performed a robotic cholecystectomy, without intra- or post-operative complications.Conclusion: The intrinsic advantages of the robotic platform and the use of Indocyanine green fluorescent cholangiography (ICG) could make dissection and identification of anatomy easier, thus possibly reducing the rates of CTO and biliary tract injuries. Robotic assisted surgery could be an option for complex cases of cholecystectomy. ICG is an additional tool that can help identify the cystic and common bile duct during the dissection of the Calot’s triangle.
Esposito S, Daskalaki D, Gonzalez-Ciccarelli LF, Giulianotti PC. Value of the Robotic Platform in a Complex Cholecystectomy: A Case Report. Clin Surg. 2016; 1: 1129.