AI Article Synopsis
- A surgery-first approach using robotic common bile duct exploration (RBCDE) offers an effective alternative for treating CBD stones in patients with gallbladders, showing equal efficacy at a lower cost compared to traditional methods.
- The RBCDE technique simplifies the process by using a cystic ductotomy and a cholangiogram to identify stones, allowing for targeted removal with different techniques based on stone size.
- This method aims to enhance the adoption of a straightforward, one-stage surgery for CBD stone treatment, overcoming technical limitations associated with traditional laparoscopic procedures.
Article Abstract
Background: Data consistently supports a surgery-first approach to common bile duct (CBD) stones in patients with a gallbladder via laparoscopic CBD exploration (LCBDE). LCBDE has equivalent efficacy and decreased cost as compared with cholecystectomy plus endoscopic retrograde cholangiopancreatography (ERCP). However, adoption has been low due to the technical limitations of laparoscopy. We describe a straightforward and highly reproducible robotic CBDE (RBCDE) technique.
Methods: A cystic ductotomy is made after obtaining a critical view of safety. Through a 5 mm port, a wire-ready cholangiogram catheter is secured in the cystic duct and intraoperative cholangiogram performed. Based on stone burden, small versus large, either an antegrade balloon snowplow (push stones forward) or sphincteroplasty is performed over a wire under fluoroscopy. If concern persists for retained stones, choledochoscopy is performed.
Conclusions: Our simplified antegrade-only RCBDE technique allows surgeons to consistently offer a surgery-first, single-stage approach to CBD stones in patients with a gallbladder.
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| http://dx.doi.org/10.1097/SLE.0000000000001339 | DOI Listing |
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