Journal Review in Minimally Invasive Surgery: Robotic Cholecystectomy and Bile Duct Injury

Behind The Knife: The Surgery Podcast

Medicine, Health & Fitness, Education, Science

4.8 • 1.4K Ratings

🗓️ 10 June 2024

⏱️ 32 minutes

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Summary

Laparoscopic cholecystectomy was introduced approximately 30 years ago and quickly became the gold standard due to multiple benefits over open cholecystectomy. It ushered in the laparoscopic revolution but also increased the number of bile duct injuries. Through the dedicated efforts of many the rate of bile duct injury has been reduced, now mirroring open cholecystectomy. The robotic surgery revolution is well underway and unsurprisingly this technology has been applied to cholecystectomy. Given the devastating nature of bile duct injury and the history of increased injury with the last major shift in operative approach, we examine the current literature on the comparative safety of robotic-assisted cholecystectomy vs. laparoscopic cholecystectomy.

1. Andrew Wright, UW Medical Center – Montlake and Northwest, @andrewswright
2. Nick Cetrulo, UW Medical Center - Northwest, @Trules25
3. Nicole White, UW Medical Center - Northwest
4. Paul Herman, UW General Surgery Resident PGY-3, @paul_herm
5. Ben Vierra, UW General Surgery Resident PGY-2 @benvierra95

Learning objectives:

1. Examine the history of the laparoscopic cholecystectomy and review the efforts to reduce bile duct injury (SAGES Safe Cholecystectomy Task Force and Multi-Society Practice Guideline)
2. Review literature on causes and prevention of bile duct injury
3. Review a recent article on robotic cholecystectomy vs laparoscopic cholecystectomy outcomes
4. Describe precautions that might mitigate expected increase in bile duct injury as a new approach is applied

References
1. https://www.sages.org/publications/guidelines/safe-cholecystectomy-multi-society-practice-guideline/
2. https://www.sages.org/safe-cholecystectomy-program/
3. MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc. 1998 Apr;12(4):315-21. doi: 10.1007/s004649900661. PMID: 9543520. https://pubmed.ncbi.nlm.nih.gov/9543520/
4. Keus F, de Jong JA, Gooszen HG, van Laarhoven CJ. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006 Oct 18;(4):CD006231. doi: 10.1002/14651858.CD006231. PMID: 17054285. https://pubmed.ncbi.nlm.nih.gov/17054285/
5. Way LW, Stewart L, Gantert W, Liu K, Lee CM, Whang K, Hunter JG. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003 Apr;237(4):460-9. doi: 10.1097/01.SLA.0000060680.92690.E9. PMID: 12677139; PMCID: PMC1514483. https://pubmed.ncbi.nlm.nih.gov/12677139/
6. Kalata S, Thumma JR, Norton EC, Dimick JB, Sheetz KH. Comparative Safety of Robotic-Assisted vs Laparoscopic Cholecystectomy. JAMA Surg. 2023;158(12):1303–1310. doi:10.1001/jamasurg.2023.4389 https://pubmed.ncbi.nlm.nih.gov/37728932/

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Transcript

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0:00.0	Behind the surgery podcast relevant and engaging content designed to help you dominate the day.
0:13.0	Hello everyone, welcome back to another episode of Behind the Night. I'm here with the rest of our
0:26.4	minimally invasive team at the University of Washington. Ben Viera, a fellow resident,
0:30.9	and our three faculty members, Dr. White, Dr. Wright, and Dr.
0:34.3	Sertrulu. Today for our general review we're going to be discussing a recent
0:38.2	paper on outcomes of robotic versus laparoscopic colocystectomy, which created quite a stir.
0:44.8	Ben, can you give us a bit of background?
0:46.6	Absolutely, thank you, Paul.
0:48.3	So as you all know, the robotic surgery revolution is well on your way in the United States
0:52.4	and abroad.
0:53.7	As discussed in our prior episodes, the robotic platform is being applied to many
0:57.7	surgical diseases, including emergency general surgery and biliary disease. There's been a sevenfold increase in the use of
1:05.2	the robot for colostectomies in the past few years, but even so the data is not really
1:10.0	clear that the robot actually improves outcomes in such surgeries.
1:14.0	Plenty of data has been published about this topic, but most of the data has been limited to
1:18.0	single series or small institution case studies.
1:21.0	So today we're going to talk about a larger paper recently published
1:24.9	last year in 2023 that shed some new light into this topic. So before we dive
1:30.5	in into this paper we thought it would be best to review where we've been and all the work that has gone into optimizing the lap coley.
1:37.0	Yes, about 30 years ago, Librarian Lavecivalisectomy quickly became the standard of care.
1:44.1	Due to overall low complication rates, lower pain, earlier return to work.
1:49.6	Originally it had concern for higher by-altlectuct injury rates but over time those rates
	...

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