AB010. Robotic assisted cholecystectomy and common bile duct exploration for symptomatic choledocholithiasis: the first Irish case

Background: Choledocholithiasis is a common presentation of gallstone disease. Sequelae of choledocholithiasis can be severe, including ascending cholangitis and gallstone pancreatitis. Although the majority of cases are now treated endoscopically, a proportion still requires surgical common bile duct (CBD) exploration. Laparoscopic CBD exploration is safe and feasible, although technically and ergonomically challenging. This is the first reported robotic assisted CBD exploration in Ireland using the dual console DaVinici Xi system.

Methods: This study shows the first robotic assisted CBD exploration using the dual console Da Vinci Xi in Ireland.

Results: A 54-year-old female had two failed attempts at endoscopic management of CBD stones. The Da Vinci Xi system was utilised. In this case, the cystic duct was opened onto the CBD. A choledochoscope was introduced into the CBD, with TilePro used to allow simultaneous visualisation of the abdominal cavity and the bile duct. Bile ducts were explored to second order intra-hepatic ducts and to the level of the duodenal ampulla. Stones were extracted using an endoscopic basket with the choledochoscope. The CBD was closed over a T-tube and the cholecystectomy was performed robotically. Post-operative cholangiography showed a clear CBD.

Conclusions: The dual console Da Vinci Xi system facilitates improved ergonomics and accuracy in exploring the CBD for choledocholithiasis. This is the first report of the use of the dual console system in conjunction with a choledochoscope in Ireland.

Keywords: Choledocholithiasis; CBD exploration; choledochoscope