ROBOTIC APPROACH TO THE MAIN BILE DUCT IN THE TREATMENT OF CHOLEDOCOLITIASIS. EXPERIENCE OF A BILIO-PANCREATIC UNIT

Introduction The aim of this paper is to analyze the validity and safety of a new program for the implementation of a robotic approach in the treatment of choledocholithiasis (CD) in a Bilio-Pancreatic Unit, evaluating morbi-mortality and hospital stay. Methods Given the controversy of which is the best therapeutic option in CD: preoperative ERCP followed by laparoscopic cholecystectomy (LC) or laparoscopic approach to the bile duct, we designed this prospective, non-randomized and single-center study with a robotic approach to the bile duct. 25 patients were included (14 women /11 males), with a mean age of 71.4 years. Preoperative abdominal ultrasound and cholangioresonance were performed in all patients. Results The robotic approach was effective in all cases: cholecystectomy and cleaning the bile duct. In the first three cases a radiological exploration was performed through the cystic duct during intervention. In all cases an exploration of the bile duct with a flexible choledoscope after choledochotomy was performed too. The mean operative time was 128.8 +/-16.9 minutes. Choledocholithiasis was confirmed in all patients. Furthermore, a patient had a papillary tumor of the distal common bile duct associated. One patient who had advanced cholecystitis had a biliary fistula. It was resolved conservatively by placing an endoscopic plastic biliary prosthesis. If we exclude the patient with the biliary fistula, the hospital stay postoperative period was 2 days. Conclusions Robotic approach in the treatment of choledocholithiasis is an effective and safe technique. In addition, postoperative morbidity and hospital stay decreases.