Giulianotti Pier Cristoforo, Quadri Pablo, Durgam Samarth, Bianco Francesco Maria
Department of Surgery, Division of General, Minimally Invasive and Robotic Surgery, University of Illinois at Chicago, IL.
Ann Surg. 2018 Jan;267(1):e7-e9. doi: 10.1097/SLA.0000000000002343.
The aim of this study is to analyze perioperative outcomes of robotic reconstruction of iatrogenic biliary injuries and describe the surgical technique in detail.
Iatrogenic bile duct injuries (BDIs) continue to be a major concern in open and laparoscopic cholecystectomy. In the past decade, robotic surgery has been applied to many different procedures showing technical advantages, especially in microsurgical fields. Few cases of robotic BDI reconstructions have been described in the literature so far. This is the first clinical series of consecutive patients undergoing robotic BDI reconstructions.
This study is a single-surgeon retrospective review of a prospectively maintained database including 14 patients who underwent robot-assisted biliary reconstruction due to iatrogenic BDIs.
In all, 14 patients underwent robot-assisted BDI reconstructions. The mean operative time, blood loss, and length of hospitalization were 280.6 min (SD = 132.0), 135.0 mL (SD = 169.7), and 8.4 days (SD = 6.7), respectively. The conversion rate to open surgery was 0%. Long-term follow-up was available in 85.7% (12 out of 14 patients) with a mean follow-up of 36.1 months (SD = 28.1). The >30-day complication rate was 14.3% (n = 2). These 2 patients presented with recurrent episodes of cholangitis due to hepatico-jejunostomy mild stenosis, which were successfully treated with transhepatic percutaneous biliary drainage and multiple dilatations.
Robot-assisted BDI reconstruction is feasible, safe, and may represent an interesting option in expert hands. It maintains all the benefits of minimally invasive surgery and seems to have technical advantages in fine dissection and microsuturing in the liver hilum (magnified microsuturing). In this series, 14 patients with major BDIs were repaired with the robotic approach, with conversion and reoperation rates of 0%. Long-term outcome evaluation requires a longer follow up and larger series, but the initial results are promising.
本研究旨在分析医源性胆管损伤机器人重建的围手术期结果，并详细描述手术技术。
医源性胆管损伤（BDIs）仍然是开腹和腹腔镜胆囊切除术中的一个主要问题。在过去十年中，机器人手术已应用于许多不同的手术，显示出技术优势，尤其是在显微外科领域。迄今为止，文献中很少描述机器人BDI重建的病例。这是首个连续患者接受机器人BDI重建的临床系列研究。
本研究是对一个前瞻性维护数据库进行的单术者回顾性分析，该数据库包括14例因医源性BDIs接受机器人辅助胆管重建的患者。
共有14例患者接受了机器人辅助BDI重建。平均手术时间、失血量和住院时间分别为280.6分钟（标准差=132.0）、135.0毫升（标准差=169.7）和8.4天（标准差=6.7）。开腹手术转化率为0%。85.7%（14例中的12例）患者获得长期随访，平均随访时间为36.1个月（标准差=28.1）。30天以上并发症发生率为14.3%（n=2）。这2例患者因肝空肠吻合口轻度狭窄出现复发性胆管炎，经肝穿刺胆道引流和多次扩张成功治疗。
机器人辅助BDI重建是可行、安全的，在专家手中可能是一个有趣的选择。它保留了微创手术的所有优点，并且在肝门精细解剖和显微缝合（放大显微缝合）方面似乎具有技术优势。在本系列研究中，14例主要BDIs患者采用机器人手术修复，转化率和再次手术率均为0%。长期结果评估需要更长时间的随访和更大规模的系列研究，但初步结果很有前景。
