Robotic biliary surgery for benign and malignant bile duct obstruction: a case series

Minimally invasive surgery for post cholecystectomy biliary stricture: current evidence and future perspectives

Postcholecystectomy bile duct injury (BDI) remains a devastating iatrogenic complication that adversely impacts the quality of life with high healthcare costs. Despite a decrease in the incidence of laparoscopic cholecystectomy-related BDI, the absolute number remains high as cholecystectomy is a commonly performed surgical procedure. Open Roux-en-Y hepaticojejunostomy with meticulous surgical technique remains the gold standard surgical procedure with excellent long-term results in most patients. As with many hepatobiliary disorders, a minimally invasive approach has been recently explored to minimize access-related complications and improve postoperative recovery. Since patients with gallstone disease are often admitted for a minimally invasive cholecystectomy, laparoscopic and robotic approaches for repairing postcholecystectomy biliary stricture are attractive. While recent series have shown the feasibility and safety of minimally invasive post-cholecystectomy biliary stricture management, most are retrospective analyses with small sample sizes. Also, long-term follow-up is available only in a limited number of studies. The principles and technique of minimally invasive repair resemble open repair except for the extent of adhesiolysis and the suturing technique with continuous sutures commonly used in minimally invasive approaches. The robotic approach overcomes key limitations of laparoscopic surgery and has the potential to become the preferred minimally invasive approach for the repair of postcholecystectomy biliary stricture. Despite increasing use, lack of prospective studies and selection bias with available evidence precludes definitive conclusions regarding minimally invasive surgery for managing postcholecystectomy biliary stricture. High-volume prospective studies are required to confirm the initial promising outcomes with minimally invasive surgery.

Pure robotic major hepatectomy with biliary reconstruction for hepatobiliary malignancies: first European results

BACKGROUND

Combined liver and bile duct resection with biliary reconstruction for hepatobiliary malignancies are defined as highly complex surgical procedures. The robotic platform may overcome some major limitations of conventional laparoscopic surgery for these complex cases but its precise role is however still to be defined.

METHODS

In our institution, patients requiring major hepatectomy with biliary reconstruction for malignancies were consecutively selected for minimally invasive robotic surgery from September 2020. All surgeries were undertaken using the da Vinci Xi Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA). Intra-operative technique and postoperative outcome were analyzed.

RESULTS

A total number of 10 patients (3 males and 7 females, median age 72 years) underwent robotic major hepatectomy and bile duct resection for hepatobiliary malignancies between September 2020 and March 2022. The indication for surgery was perihilar cholangiocarcinoma in 5 of 10 patients. Median operative time was 338 min and median blood loss was 110 mL. Postoperative length of stay was between 3 and 16 days (median: 9 days). There was no postoperative 90-day mortality.

CONCLUSIONS

A robotic approach for hepatobiliary malignancies requiring combined major hepatectomy and bile duct resection seems feasible and safe in experienced hands.

Piezo robotic hand for motion manipulation from micro to macro

Multiple degrees of freedom (DOFs) motion manipulation of various objects is a crucial skill for robotic systems, which relies on various robotic hands. However, traditional robotic hands suffer from problems of low manipulation accuracy, poor electromagnetic compatibility and complex system due to limitations in structures, principles and transmissions. Here we present a direct-drive rigid piezo robotic hand (PRH) constructed on functional piezoelectric ceramic. Our PRH holds four piezo fingers and twelve motion DOFs. It achieves high adaptability motion manipulation of ten objects employing pre-planned functionalized hand gestures, manipulating plates to achieve 2L (linear) and 1R (rotary) motions, cylindrical objects to generate 1L and 1R motions and spherical objects to produce 3R motions. It holds promising prospects in constructing multi-DOF ultra-precision manipulation devices, and an integrated system of our PRH is developed to implement several applications. This work provides a new direction to develop robotic hand for multi-DOF motion manipulation from micro scale to macro scale.