Robot-Assisted Surgery and Holmium Laser in Complex Choledocholithiasis

Introduction: Unsolved choledocholithiasis by endoscopic retrograde cholangiopancreatography is a complicated condition to manage. The incorporation of robotic surgery, a choledochoscope, and a holmium laser as therapeutic tools is likely to increase surgery effectiveness. Our purpose is to present the first Latin American case report of the combined use of these tools to extract a large impacted bile duct stone. Case Description: A 42-year-old man with obstructive jaundice syndrome underwent endoscopic retrograde cholangiopancreatography. Bile duct dilatation was evidenced by a 1.5-cm-diameter stone that could not be extracted, and biliary prosthesis placement was not possible. Given that stone clearance was not achieved, robot-assisted laparoscopic common bile duct exploration using a holmium laser for lithotripsy was performed. The entire procedure was performed with a robot-assisted technique. The docking time and console time were 10 minutes and 120 minutes, respectively. The patient progressed satisfactorily and was discharged after 48 hours without complications. He had no evidence of residual common bile duct stones or duct strictures after 12 months of follow-up. Discussion: Laparoscopic common bile duct exploration is an excellent option for the treatment of common bile duct stones. The holmium laser is a useful tool for the treatment of complex choledocholithiasis. Incorporation of the da Vinci System (Intuitive Surgical, Sunnyvale, California) allows greater precision and effectiveness, thus increasing surgery success rates.