Robotic cholecystectomy with cholecystoduodenal fistula takedown

Presenter: Nelson A Royall MD | Utica Park Clinic Background: Cholecystoenteric fistulae are complex procedures which commonly performed using an open approach. Due to the increased risk for peri-operative morbidity, these often referred ot Hepatobiliary Surgery centers management. Laparoscopic management of cholecystoenteric is challenging and has a significant learning curve may not be easily reproducible at majority centers. There availability adoption robotic techniques hepatobiliary procedures, including biliary duodenal procedures. Methods: 52-year-old female presented with history one month refractory severe right upper quadrant abdominal pain. CT abdomen/pelvis demonstrated contracted gallbladder intraluminal air concerning cholecystoduodenal fistula. She underwent aborted laparoscopic cholecystectomy by outside General Surgeon placement cholecystostomy tube. was initiated on empiric piperacillin-tazobactam transferred multiphasic computed tomography fistula D1 portion duodenum without mass appearance or aberrant vascular anatomy. Given her symptoms hemodynamic stability, she planned definitive surgical Results: The patient takedown primary transverse duodenorrhaphy Operative duration 120 minutes estimated blood loss 25mL. An intra-operative cholangiogram normal intra- extra-hepatic anatomy filling defect stricture. Pathology acute chronic cholecystitis malignancy. Post-operatively, drain removed fourth post-operative day after tolerating regular diet evidence leakage. At 30-day follow-up had resolution prior complication. Conclusion: Surgical complicated due frequent inflammatory changes enteric leak. current standard practice resection repair. Minimally-invasive approaches have been limited in techniques. improved development platforms potential increase minimally-invasive options patients this disease. Consideration can considered platform experience.