Robotic-assisted completion cholecystectomy following previous subtotal cholecystectomy - a case series

Abstract

Background: Subtotal cholecystectomy remains a viable and safe option when intraoperative conditions preclude visualization of the Critical View of Safety. 1.8% of these patients eventually require a reoperation. Traditionally, completion cholecystectomy following subtotal cholecystectomy required an open approach. In this study, we present our single institution experience with 16 robotic-assisted completion cholecystectomies following previous subtotal cholecystectomy. Methods: Operating room logs were reviewed from 2010–2017 to identify all robotic cholecystectomies performed at our institution. Review of all operative reports identified 16 completion cholecystectomies following a previous subtotal cholecystectomy. All additional variables including demographics, operative variables, and postoperative outcomes were collected from EMR records. Results: Median time from previous subtotal cholecystectomy to robotic completion cholecystectomy was 84 months (7 years). 58.3% of patients previously underwent an open subtotal cholecystectomy. The remaining patients underwent a laparoscopic subtotal cholecystectomy. Additional demographics and outcomes can be seen in Table 1. One patient required oral antibiotics for incisional site erythema. No patients required a conversion to an open procedure and average length of stay was 1.1 days. Conclusion: Although traditionally performed with an open approach, we have had success in recent years at our institution with a robotic-assisted approach to completion cholecystectomy. The robotic platform offers certain advantages in a hostile, reoperative field which allows these procedures to be performed in a minimally invasive fashion with a low rate of conversion. Previously limited to case reports, this series of 16 procedures represents the largest case series of robot-assisted completion cholecystectomies to date.