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Stefanova I, Alkhatib O, Sheel A, Alabraba E, Alibrahim M, Arshad A, Awan A, Baron R, Bhatti I, Bhogal R, Dhakshinamoorthy V, Diaz-Nieto R, Dunne D, Frampton AE, Green A, Hajibandeh S, Hamady Z, Horgan L, Kissane E, Krishnan S, Kumar R, Lahiri R, Lam S, Liau SS, Marangoni G, Moudhgalya S, Papadopoulos G, Pencavel T, Picker S, Ramsingh J, Riga A, Silva M, Soonawalla Z, Subar D, Sud V, Upasani V, Wong V, Worthington T, Yeung KTD, Ahmad J. Safety of robotic cholecystectomy as index training procedure: the UK experience. Surg Endosc 2024; 38:4880-4886. [PMID: 38955837 DOI: 10.1007/s00464-024-11006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
AIMS To evaluate the safety profile of robotic cholecystectomy performed within the United Kingdom (UK) Robotic Hepatopancreatobiliary (HPB) training programme. METHODS A retrospective evaluation of prospectively collected data from eleven centres participating in the UK Robotic HPB training programme was conducted. All adult patients undergoing robotic cholecystectomy for symptomatic gallstone disease or gallbladder polyp were considered. Bile duct injury, conversion to open procedure, conversion to subtotal cholecystectomy, length of hospital stay, 30-day re-admission, and post-operative complications were the evaluated outcome parameters. RESULTS A total of 600 patients were included. The median age was 53 (IQR 65-41) years and the majority (72.7%; 436/600) were female. The main indications for robotic cholecystectomy were biliary colic (55.5%, 333/600), cholecystitis (18.8%, 113/600), gallbladder polyps (7.7%, 46/600), and pancreatitis (6.2%, 37/600). The median length of stay was 0 (IQR 0-1) days. Of the included patients, 88.5% (531/600) were discharged on the day of procedure with 30-day re-admission rate of 5.5% (33/600). There were no bile duct injuries and the rate of conversion to open was 0.8% (5/600) with subtotal cholecystectomy rate of 0.8% (5/600). CONCLUSION The current study confirms that robotic cholecystectomy can be safely implemented to routine practice with a low risk of bile duct injury, low bile leak rate, low conversion to open surgery, and low need for subtotal cholecystectomy.
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Affiliation(s)
- Irena Stefanova
- Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK.
| | - Omar Alkhatib
- Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK
| | - Andrea Sheel
- Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK
| | | | | | - Ali Arshad
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Altaf Awan
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Ryan Baron
- Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK
| | - Imran Bhatti
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Ricky Bhogal
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Declan Dunne
- Royal Liverpool Hospital NHS Foundation Trust, Liverpool, UK
| | - Adam E Frampton
- Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK
| | - Alexander Green
- Northumbria Healthcare NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | - Shahin Hajibandeh
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Zaed Hamady
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Liam Horgan
- Northumbria Healthcare NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | - Eleanor Kissane
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | | | - Rajesh Kumar
- Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK
| | - Rajiv Lahiri
- Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK
| | - Shi Lam
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Siong-Seng Liau
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Shyam Moudhgalya
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | | | - Tim Pencavel
- Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK
| | - Sarah Picker
- Northumbria Healthcare NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | - Jason Ramsingh
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle-Upon-Tyne, UK
| | - Angela Riga
- Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK
| | - Michael Silva
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Daren Subar
- East Lancashire Hospitals NHS Trust, Burnley, UK
| | - Vikas Sud
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Vincent Wong
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Tim Worthington
- Royal Surrey County Hospital NHS Foundation Trust, Guilford, UK
| | | | - Jawad Ahmad
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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2
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Mellado S, Chirban AM, Shapera E, Rivera B, Panettieri E, Vivanco M, Conrad C, Sucandy I, Vega EA. Innovations in surgery for gallbladder cancer: A review of robotic surgery as a feasible and safe option. Am J Surg 2024; 233:37-44. [PMID: 38443272 DOI: 10.1016/j.amjsurg.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND This study evaluates the efficacy and safety of robotic-assisted surgical techniques in the treatment of gallbladder cancer, comparing it with traditional open and laparoscopic methods. METHODS A systematic review of the literature searched for comparative analyses of patient outcomes following robotic, open, and laparoscopic surgeries, focusing on oncological results and perioperative benefits. RESULTS Five total studies published between 2019 and 2023 were identified. Findings indicate that robotic-assisted surgery for gallbladder cancer is as effective as traditional methods in terms of oncological outcomes, with potential advantages in precision and perioperative recovery. CONCLUSIONS Robotic surgery offers a viable and potentially advantageous alternative for gallbladder cancer treatment, warranting further research to confirm its benefits and establish comprehensive surgical guidelines.
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Affiliation(s)
- Sebastian Mellado
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Ariana M Chirban
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA; University of California San Diego School of Medicine, San Diego, CA, USA
| | - Emanuel Shapera
- Digestive Health Institute, Advent Health Tampa, Tampa, FL, USA
| | - Belen Rivera
- Department of Surgery, Clinica Alemana de Santiago, Santiago, Chile
| | - Elena Panettieri
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcelo Vivanco
- Department of Surgery, Clinica Alemana de Santiago, Santiago, Chile
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Iswanto Sucandy
- Digestive Health Institute, Advent Health Tampa, Tampa, FL, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA.
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3
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McCarron FN, Vrochides D, Martinie JB. Current progress in robotic hepatobiliary and pancreatic surgery at a high-volume center. Ann Gastroenterol Surg 2023; 7:863-870. [PMID: 37927925 PMCID: PMC10623982 DOI: 10.1002/ags3.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/18/2023] [Accepted: 08/19/2023] [Indexed: 11/07/2023] Open
Abstract
There has been steady growth in the adoption of robotic HPB procedures world-wide over the past 20 years, but most of this increase has occurred only recently. Not surprisingly, the vast majority of robotics has been in the United States, with very few, select centers of adoption in Italy, South Korea, and Brazil, to name a few. We began our robotic HPB program in 2008, well before almost all other centers in the world, with the most notable exception of Giullianotti and colleagues. Our program began gradually, with smaller cases carefully selected to optimize the strengths of the original robotic platform and included complex biliary and pancreatic resections. We performed the first reported series of choledochojejunostomy for benign biliary strictures and first series of completion cholecystectomies. We began performing robotic distal pancreatectomies and longitudinal pancreaticojejunostomies, reporting our early experience for each of these procedures. Over time we progressed to robotic pancreaticoduodenectomies. Initially, these were performed with planned conversions until we were able to optimize efficiency. Now we have performed over 200 robotic whipples, reaching a 100% robotic completion rate by 2020. Finally, we have added robotic major hepatectomies, including resections for hilar cholangiocarcinoma to our repertoire. Since the program began, we have performed over 1600 robotic HPB cases. Outcomes from our program have shown superior lymph node harvest, lower DGE rates, shorter hospitalizations, and fewer rehab admissions with similar overall complications to open and laparoscopic procedures, signifying that over time a robotic HPB program is not only feasible but advantageous as well.
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Affiliation(s)
- Frances N. McCarron
- Department of Hepatobiliary and Pancreas SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Dionisios Vrochides
- Department of Hepatobiliary and Pancreas SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
| | - John B. Martinie
- Department of Hepatobiliary and Pancreas SurgeryCarolinas Medical CenterCharlotteNorth CarolinaUSA
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4
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Hurwitz JC, Kolwitz CE, Kim DY, Petrone P, Halpern DK. Robotic-assisted completion cholecystectomy with repair of cholecystoduodenal fistula. J Surg Case Rep 2023; 2023:rjad251. [PMID: 37201105 PMCID: PMC10187471 DOI: 10.1093/jscr/rjad251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/12/2023] [Indexed: 05/20/2023] Open
Abstract
Post-cholecystectomy syndrome (PCS) is a well-documented complication of incomplete cholecystectomy. The etiology is often post-surgical chronic inflammation from unresolved cholelithiasis, which is secondary to anatomical abnormalities, including a retained gallbladder or a large cystic duct remnant (CDR). An exceedingly rare consequence is retained gallstone fistulization into the gastrointestinal tract. We present a case of a 70-year-old female with multiple comorbidities 4 years status-post incomplete cholecystectomy, who developed PCS with cholecystoduodenal fistula secondary to retained gallstone in the remnant gallbladder, with CDR involvement, treated via robotic-assisted surgery. Reoperation in PCS has been traditionally performed via laparoscopic approach with recent advances made in robotic-assisted surgery. However, we report the first documented case of PCS complicated by bilioenteric fistula repaired with robotic-assisted surgery. This highlights the value of robotic-assisted surgery in complicated cases, where one must contend with post-surgical anatomic abnormalities and visualization difficulties. Subsequent investigation is necessary to objectively quantify the safety and reproducibility of our approach.
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Affiliation(s)
- Joshua C Hurwitz
- Department of Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Christine E Kolwitz
- Department of Abdominal Transplant Surgery, Oregon Health and Science University Hospital; Portland, OR, USA
| | - David Y Kim
- Department of Radiology, New York University Langone Hospital-Long Island, Mineola, NY, USA
| | - Patrizio Petrone
- Correspondence address. Department of Surgery, NYU Langone Hospital—Long Island, 222 Station Plaza N., Suite 300. Tel: (516) 663-9571; E-mail:
| | - David K Halpern
- Department of Surgery, NYU Langone Hospital-Long Island, Mineola, NY, USA
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5
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Chao P, Chandhok S, Koea J, Srinivasa S. Letter Regarding: Robotic Cholecystectomies: What are They Good for?-A Retrospective Study of Robotic Versus Conventional Cases. J Surg Res 2023; 281:335-336. [PMID: 36202667 DOI: 10.1016/j.jss.2022.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Phillip Chao
- Upper GI Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand; Waitematā Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Simran Chandhok
- Upper GI Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand; Waitematā Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Jonathan Koea
- Upper GI Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand; Waitematā Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Sanket Srinivasa
- Upper GI Unit, Department of Surgery, North Shore Hospital, Auckland, New Zealand; Waitematā Clinical Campus, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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6
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Khanna S, Barua A. Robotic assisted cholecystectomy – A retrospective cohort study of experience of 106 first robotic cholecystectomies in versius robotic platform. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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7
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Chandhok S, Chao P, Koea J, Srinivasa S. Robotic-assisted cholecystectomy: Current status and future application. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022. [DOI: 10.1016/j.lers.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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8
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Tschuor C, Pickens RC, Isenberg EE, Motz BM, Salibi PN, Robinson JN, Murphy KJ, Iannitti DA, Baker EH, Vrochides D, Martinie JB. Robotic Resection of Gallbladder Cancer: A Single-Center Retrospective Comparative Study to Open Resection. Am Surg 2021:31348211047491. [PMID: 34652250 DOI: 10.1177/00031348211047491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Minimally invasive surgery is gaining support for resection of gallbladder cancer (GBC). This study aims to compare operative and early outcomes of robotic resection (RR) to open resection (OR) from a single institution performing a high volume of robotic HPB surgery. METHODS Twenty patients with GBC underwent RR from January 2013 to August 2019. Outcomes were compared to a historical control of 23 patients with OR. Radical cholecystectomy for suspected GBC and completion operations for incidental GBC after routine cholecystectomy were both included. RESULTS Robotic resection had lower blood loss compared to OR (150 vs 350 mL, P = .002) and shorter postoperative length of stay (2.5 vs 6 days, P < .001), while median operative time was similar (193 vs 208 min, P = .604). There were no statistical differences in 30-day major complications or readmissions. No 30-day mortalities occurred. There was no statistical difference in survival trend (P = .438) or median lymph node harvest (5 vs 3, P = .189) for RR compared to OR. CONCLUSION Robotic resection of GBC is safe and efficient, with lower length of hospital stay and blood loss compared to OR. Technical benefits of robotic-assisted surgery may prove advantageous though larger studies are still needed.
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Affiliation(s)
- Christoph Tschuor
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.,Department of Surgical Gastroenterology and Transplantation, 53146Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, 4321University of Copenhagen, Copenhagen, Denmark
| | - Ryan C Pickens
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Erin E Isenberg
- School of Medicine, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin M Motz
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Patrick N Salibi
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Jordan N Robinson
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Keith J Murphy
- Carolinas Center for Surgical Outcomes Science, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - David A Iannitti
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Erin H Baker
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - John B Martinie
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
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9
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Tschuor C, Lyman WB, Passeri M, Salibi PN, Baimas-George M, Iannitti DA, Baker EH, Vrochides D, Martinie JB. Robotic-assisted completion cholecystectomy: A safe and effective approach to a challenging surgical scenario - A single center retrospective cohort study. Int J Med Robot 2021; 17:e2312. [PMID: 34261193 DOI: 10.1002/rcs.2312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Reoperation following a previous subtotal or aborted cholecystectomy presents a challenging surgical scenario that has traditionally required an open completion cholecystectomy. The aim of this study was to describe an institutional experience with a robotic-assisted approach to completion cholecystectomy. METHODS A database was retrospectively audited to identify all patients who underwent robotic-assisted cholecystectomy performed by two hepatopancreatobiliary surgeons at a single centre from 2010 to 2019. RESULTS Twenty six patients who underwent a robotic-assisted completion cholecystectomy were identified. Median operative time was 142 min (48-247 min) with a blood loss of 50 cc (0-500 cc). Minor complications (Clavien-Dindo ≤ II 90 days) occurred in three patients (11.5%) with no major complication or mortality reported. Median hospital length of stay was 1 day (0-6 days) with one patient readmitted. CONCLUSION This study represents to our knowledge the largest series of robotic-assisted completion cholecystectomies to date. The robotic approach appears to be a safe and effective procedure associated with a low morbidity and high success rate.
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Affiliation(s)
- Christoph Tschuor
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA.,Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - William B Lyman
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Michael Passeri
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Patrick N Salibi
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Maria Baimas-George
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - David A Iannitti
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Erin H Baker
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
| | - John B Martinie
- Division of HPB Surgery, Department of General Surgery, Atrium Health - Carolinas Medical Center, Charlotte, North Carolina, USA
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10
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Cawich SO, Mohanty SK, Bonadie K, Simpson L, Ramnarace R, Fa Si Oen P, Singh Y, Naraynsingh V, Francis W. Laparoscopic Completion Cholecystectomy: An Audit from the Americas Hepato-Pancreato-Biliary Association (AHPBA) Caribbean Chapter. Cureus 2020; 12:e11126. [PMID: 33240719 PMCID: PMC7682921 DOI: 10.7759/cureus.11126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective Removal of a gallbladder remnant occasionally becomes necessary when retained stones become symptomatic. Although the laparoscopic approach has been described, it is not yet considered the standard of care. We sought to determine the outcomes after completion cholecystectomies in the resource-poor setting within the Caribbean. Methods We carried out an audit of the databases from all hepatobiliary surgeons in the Anglophone Caribbean. We identified all patients who had completion cholecystectomy over the five-year period from July 1, 2012 to June 30, 2018. Retrospective chart review was performed to extract the following data: patient demographics, diagnoses, presenting complaints, operative details, morbidity, mortality, and clinical outcomes. Descriptive statistics were generated using Statistical Packaging for Social Sciences (SPSS), version 12.0 (SPSS Inc., Chicago IL) Results There were 12 patients who were subjected to laparoscopic completion cholecystectomy for acute cholecystitis (7), severe biliary pancreatitis (3), and chronic cholecystitis (2) secondary to stones in a gallbladder remnant. There were 10 women and two men at a mean age of 47.4 years (range 32-60; standard deviation (SD) +/-7.81; median 48; mode 52) and a mean body mass index (BMI) of 30.8 Kg/M2 (SD +/-3.81; range 26-38; median 29.5). The mean interval between the index operation and the completion operation was 14.8 months (SD +/- 12.3; range 1-48; median 13; mode 18). Five (42%) patients had their original cholecystectomy using the open approach. Five (42%) index operations were done on an emergent basis and the gallbladder remnant was deliberately left behind in three (25%) index operations. The completion cholecystectomies were all completed laparoscopically in 130.5 minutes (SD +/- 30.5; range 90-180, median 125; mode 125) without any conversions or mortality. There were two minor bile leaks that resolved without intervention through an indwelling drain. Discussion Completions cholecystectomy can be completed via the laparoscopic approach with good outcomes and acceptable morbidity and mortality rates. The patients derive the same advantages as elective cholecystectomies. Therefore, the laparoscopic approach, when performed by hepatobiliary surgeons with advanced laparoscopic expertise in specialized centers, should be the new standard of care.
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Affiliation(s)
| | | | - Kimon Bonadie
- Surgery, Cayman Islands National Hospital, Grand Cayman, CYM
| | | | - Rene Ramnarace
- Gastroenterology, Southern Medical Hospital, San Fernando, TTO
| | | | - Yardesh Singh
- Surgery, University of the West Indies, St. Augustine, TTO
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11
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Magge D, Steve J, Novak S, Slivka A, Hogg M, Zureikat A, Zeh HJ. Performing the Difficult Cholecystectomy Using Combined Endoscopic and Robotic Techniques: How I Do It. J Gastrointest Surg 2017; 21:583-589. [PMID: 27896657 DOI: 10.1007/s11605-016-3323-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/09/2016] [Indexed: 01/31/2023]
Abstract
Laparoscopic cholecystectomy is the standard of care for cholelithiasis as well as cholecystitis. However, in the setting of Mirizzi syndrome or gangrenous cholecystitis where the critical view cannot be ascertained, subtotal cholecystectomy may be necessary. Using the robot-assisted approach, difficult cholecystectomies can be performed upfront without need for partial cholecystectomy. Even in the setting of Mirizzi syndrome where severe scarring and fibrosis are evident, definitive cholecystectomy and takedown of the cholechystocholedochal fistula can be performed in a safe and feasible fashion following successful endoscopic common bile duct stent placement. The purposes of this report are to review the history of Mirizzi syndrome as well as its traditional and novel treatment techniques and highlight technical pearls of the robotic approach to this diagnosis.
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Affiliation(s)
- Deepa Magge
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA.
| | - Jennifer Steve
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Stephanie Novak
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Adam Slivka
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Mellissa Hogg
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Amer Zureikat
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Herbert J Zeh
- Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 5150 Centre Ave, Suite 417, Pittsburgh, 15232, USA
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12
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Hanna EM, Rozario N, Rupp C, Sindram D, Iannitti DA, Martinie JB. Robotic hepatobiliary and pancreatic surgery: lessons learned and predictors for conversion. Int J Med Robot 2013; 9:152-9. [DOI: 10.1002/rcs.1492] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Erin M. Hanna
- Department of General Surgery, Division of Hepatobiliary and Pancreatic Surgery; Carolinas Medical Center; Charlotte NC USA
| | - Nigel Rozario
- Dixon Institute; Carolinas Medical Center; Charlotte NC USA
| | - Christopher Rupp
- Department of Surgery, Division of Gastrointestinal Surgery; University of North Carolina; Chapel Hill NC USA
| | - David Sindram
- Department of General Surgery, Division of Hepatobiliary and Pancreatic Surgery; Carolinas Medical Center; Charlotte NC USA
| | - David A. Iannitti
- Department of General Surgery, Division of Hepatobiliary and Pancreatic Surgery; Carolinas Medical Center; Charlotte NC USA
| | - John B. Martinie
- Department of General Surgery, Division of Hepatobiliary and Pancreatic Surgery; Carolinas Medical Center; Charlotte NC USA
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