How I Do It: Simplified Transcystic Antegrade-only Robotic Common Bile Duct Exploration (RCBDE)

Eleah D Porter; Michael Carge; Heather O'Field; Mohamed Kelli; Sarah E Johnson; Ralph Wesley Vosburg; Byron Fernando Santos

doi:10.1097/SLE.0000000000001339

How I Do It: Simplified Transcystic Antegrade-only Robotic Common Bile Duct Exploration (RCBDE)

Surg Laparosc Endosc Percutan Tech. 2024 Nov 22. doi: 10.1097/SLE.0000000000001339. Online ahead of print.

Authors

Eleah D Porter¹, Michael Carge¹, Heather O'Field¹, Mohamed Kelli¹, Sarah E Johnson¹, Ralph Wesley Vosburg¹, Byron Fernando Santos^{2

3}

Affiliations

¹ Department of Surgery, Grand Strand Medical Center, Myrtle Beach, SC.
² Veterans Affairs Medical Center, White River Junction, VT.
³ Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

PMID: 39575896
DOI: 10.1097/SLE.0000000000001339

Abstract

Background: Data consistently supports a surgery-first approach to common bile duct (CBD) stones in patients with a gallbladder via laparoscopic CBD exploration (LCBDE). LCBDE has equivalent efficacy and decreased cost as compared with cholecystectomy plus endoscopic retrograde cholangiopancreatography (ERCP). However, adoption has been low due to the technical limitations of laparoscopy. We describe a straightforward and highly reproducible robotic CBDE (RBCDE) technique.

Methods: A cystic ductotomy is made after obtaining a critical view of safety. Through a 5 mm port, a wire-ready cholangiogram catheter is secured in the cystic duct and intraoperative cholangiogram performed. Based on stone burden, small versus large, either an antegrade balloon snowplow (push stones forward) or sphincteroplasty is performed over a wire under fluoroscopy. If concern persists for retained stones, choledochoscopy is performed.

Conclusions: Our simplified antegrade-only RCBDE technique allows surgeons to consistently offer a surgery-first, single-stage approach to CBD stones in patients with a gallbladder.