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D'Hondt M, Wicherts DA. Robotic biliary surgery for benign and malignant bile duct obstruction: a case series. J Robot Surg 2023; 17:55-62. [PMID: 35312931 DOI: 10.1007/s11701-022-01392-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/18/2022] [Indexed: 11/29/2022]
Abstract
The majority of patients with benign or malignant biliary obstruction require surgical treatment with a bilio-enteric anastomosis. This requires fine dissection and advanced suturing. Robotic surgery may overcome some major limitations of conventional laparoscopic surgery. The precise role of robotic biliary surgery is, however, still to be defined. In our institution, patients requiring complex bile duct surgery 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. A total number of 14 patients underwent robotic biliary surgery for a variety of benign and malignant indications between September 2020 and May 2021. Six of fourteen patients (43%) had previous open abdominal surgery. Median blood loss was 25 mL (range 10-120 mL). There were no intra-operative complications and no conversions. Length of stay was between 3 and 11 days without major postoperative morbidity. Robotic surgery for benign and malignant bile duct obstruction is efficient and safe in experienced hands. Referral to a high-volume expert center is, however, advised.
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Affiliation(s)
- Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
| | - Dennis A Wicherts
- Department of Abdominal and Hepatobiliary/Pancreatic Surgery, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
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2
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Cubisino A, Dreifuss NH, Cassese G, Bianco FM, Panaro F. Minimally invasive biliary anastomosis after iatrogenic bile duct injury: a systematic review. Updates Surg 2023; 75:31-39. [PMID: 36205829 DOI: 10.1007/s13304-022-01392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/27/2022] [Indexed: 01/14/2023]
Abstract
Major bile duct injuries (BDIs) may require complex surgical repairs that are usually performed with a conventional open approach. This study aims to analyze current evidence concerning the safety and the outcomes of the minimally invasive (MI) approach for biliary anastomosis in post-cholecystectomy BDIs. A systematic search of MEDLINE, Embase, and Web-Of-Science indexed studies involving MI (laparoscopic or robotic) biliary anastomosis in patients with iatrogenic BDIs was performed. The quality of the studies was assessed using the MINORS criteria. A total of 13 studies involving 198 patients were included. One hundred and twenty-five patients (63.1%) underwent a laparoscopic biliary anastomosis, while 73 (36.1%) received an analogue robotic procedure. All the included BDIs were types D and E (E1-E5). The mean OT varied between 190 and 330 (mean = 227) minutes. Ten studies reported the mean intraoperative blood loss that ranged between 50 and 252 (mean = 135.9) mL. No conversions occurred in the robotic series, while four patients required conversion to open surgery among the laparoscopic ones. The mean length of postoperative hospital stay was 6.3 days. The reported overall morbidity was similar among the robotic and laparoscopic series. During the follow-up period, no surgery-related mortality occurred. A growing number of referral centers are showing the safety and feasibility of the MI approach for biliary anastomosis in patients with major BDIs. Further prospective comparative studies are needed to draw more definitive conclusions.
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Affiliation(s)
- Antonio Cubisino
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA.
| | - Nicolas H Dreifuss
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Gianluca Cassese
- Department of Clinical Medicine and Surgery, Minimally Invasive and Robotic HPB Surgery Unit, Federico II University, Naples, Italy
| | - Francesco M Bianco
- Division of General, Minimally Invasive and Robotic Surgery Unit, Department of Surgery, University of Illinois at Chicago, 840 S Wood Street, Suite 435 E, Clinical Sciences Building, Chicago, IL, 60612, USA
| | - Fabrizio Panaro
- Division of HBP Surgery and Transplantation, Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France
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3
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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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4
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Morrell ALG, Morrell AC, Morrell-Junior AC, Mendes JM, Tustumi F, Morrell AG. INDOCYANINE GREEN FLUORESCENCE IMAGING IN ROBOTIC SURGERY: STATE OF ART, TIPS AND TRICKS IN CURRENT APPLICATIONS. ARQUIVOS DE GASTROENTEROLOGIA 2021; 58:61-70. [PMID: 33909799 DOI: 10.1590/s0004-2803.202100000-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fluorescent imaging with indocyanine green is an emerging technology whose benefits are put in perspective. OBJECTIVE This article reports essential principles and approaches of intraoperative fluorescence in general surgery bringing familiarity to its practical usage. Our group describes possible pitfalls and provides tips and tricks for training surgeons making their attempts easier and reproducible during practice. METHODS This study overviews the most structured concepts, practical applications and its tricks in robotic fluorescence guided imaging surgery with indocyanine green. Possible pitfalls are emphasized and emerging fields of application are put in a perspective. RESULTS Guided information and practical applications in several surgical fields are described for a safe and reproducible indocyanine green fluorescence imaging use. CONCLUSION Robotic assisted surgery combined to fluorescence imaging technology represents a logical evolution in image guided surgery and technology familiarity with guided information may represent a wider and safer spectrum of use in surgeons' hands.
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Affiliation(s)
- Andre Luiz Gioia Morrell
- Cirurgia Robótica, Instituto Morrell, São Paulo, SP, Brasil.,Cirurgia Geral e Cirurgia do Aparelho Digestivo, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Cirurgia Robótica, Rede D'Or São Luiz, São Paulo, SP, Brasil
| | - Alexander Charles Morrell
- Cirurgia Robótica, Instituto Morrell, São Paulo, SP, Brasil.,Cirurgia Robótica, Rede D'Or São Luiz, São Paulo, SP, Brasil
| | - Alexander Charles Morrell-Junior
- Cirurgia Robótica, Instituto Morrell, São Paulo, SP, Brasil.,Cirurgia Geral e Cirurgia do Aparelho Digestivo, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Cirurgia Robótica, Rede D'Or São Luiz, São Paulo, SP, Brasil
| | - Jose Mauricio Mendes
- Cirurgia Robótica, Instituto Morrell, São Paulo, SP, Brasil.,Cirurgia Geral e Cirurgia do Aparelho Digestivo, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil.,Cirurgia Robótica, Rede D'Or São Luiz, São Paulo, SP, Brasil
| | - Francisco Tustumi
- Cirurgia Geral e Cirurgia do Aparelho Digestivo, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | - Allan Gioia Morrell
- Cirurgia Robótica, Instituto Morrell, São Paulo, SP, Brasil.,Cirurgia Robótica, Rede D'Or São Luiz, São Paulo, SP, Brasil
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Application of Laparoscopic Technique in the Treatment of Hepatolithiasis. Surg Laparosc Endosc Percutan Tech 2020; 31:247-253. [PMID: 33252577 DOI: 10.1097/sle.0000000000000871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022]
Abstract
Hepatolithiasis is commonly encountered in Southeastern and East Asian countries, and its incidence is increasing in Western countries. For symptomatic hepatolithiasis or asymptomatic hepatolithiasis with signs of liver atrophy or malignancy, surgical intervention is needed, especially when peroral cholangioscopy and percutaneous transhepatic cholangioscopic lithotomy are not suitable or fail to be performed. Currently, laparoscopic surgery is gradually replacing traditional open surgery and becoming a better option. Various types of laparoscopic surgeries, including laparoscopic hepatectomy, laparoscopic biliary exploration through the common bile duct or the hepatic duct stump, and robotic-assisted laparoscopic surgery, have been developed for the treatment of simple hepatolithiasis, hepatolithiasis concomitant with choledocholithiasis, recurrent hepatolithiasis, and complicated hepatolithiasis. The related clinical experience is gradually accumulating. In this review, the laparoscopic applications and their advantages will be summarized. In most cases, the laparoscopic technique could provide the advantages of less trauma, reduced blood loss, and faster postoperative recovery.
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Machado MA, Mattos BV, Lobo Filho MM, Makdissi F. Robotic Resection of Hilar Cholangiocarcinoma. Ann Surg Oncol 2020; 27:4166-4170. [PMID: 32363511 DOI: 10.1245/s10434-020-08514-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hilar cholangiocarcinoma is the most common malignant neoplasm of the biliary tract. Surgical resection is the only curative modality of treatment. The aim of this video is to present a robotic left hepatectomy extended to caudate lobe, combined with bile duct resection, lymphadenectomy, and Roux-en-Y biliary reconstruction. METHODS A 76-year-old female presented with progressive jaundice due to hilar cholangiocarcinoma. She underwent chemoradiation and after 5 months of treatment was referred for second opinion; imaging reevaluation showed objective response and no arterial invasion. Multidisciplinary team decided for radical treatment, which consisted in robotic left hepatectomy, caudate lobe resection, resection of bile duct, lymphadenectomy, and hepaticojejunostomy. RESULTS Operative time was 8 h. Estimated blood loss was 740 mL (received 2 U). The patient's recovery was complicated by drainage clogging resulting in fever and perihepatic fluid collection, successfully treated by change of drainage. Pathology confirmed cholangiocarcinoma with free surgical margins (T1aN0). The patient is well, with no signs of disease 5 months after the procedure. CONCLUSIONS Robotic resection of hilar cholangiocarcinoma is feasible and safe. The robotic approach has some technical advantages over laparoscopic approach. This video may help oncological surgeons to perform this complex procedure.
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Affiliation(s)
- Marcel Autran Machado
- Department of Surgery, University of São Paulo, São Paulo, Brazil. .,Nove de Julho Hospital, São Paulo, Brazil.
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Guerra F, Coletta D, Gavioli M, Coco D, Patriti A. Minimally invasive surgery for the management of major bile duct injury due to cholecystectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:157-163. [PMID: 31945263 DOI: 10.1002/jhbp.710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/14/2019] [Accepted: 12/19/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Francesco Guerra
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
| | - Diego Coletta
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
| | - Manuel Gavioli
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
| | - Danilo Coco
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
| | - Alberto Patriti
- Division of General Surgery Ospedali Riuniti Marche Nord Pesaro Italy
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