Technique of Robotic Bile Duct Exploration and Closure of Common Bile Duct. An American College of Surgeons Highlights After Annual Clinical Congress
Gallstones or cholelithiasis is a common problem in general surgery requiring surgical treatment called cholecystectomy. In the majority of patients, laparoscopic cholecystectomy is a straightforward simple procedure that is offered as an outpatient operation. An admission to the hospital is therefore rarely necessary.
In 5-10% of patients, however, this problem is not so simple. The patient presented with fever and jaundice (yellowing of eyes and darkening of urine) which indicate an obstruction of the bile duct. One or more gallstones migrate from the gallbladder into the lower bile duct, where the biliary duct meets with the pancreatic duct before entering the small bowel called the duodenum. In this circumstance, a simple cholecystectomy does not address the stones that have migrated into the bile duct (choledocholithiasis). The common bile duct stones need to be removed in addition to the cholecystectomy. In most hospitals and gastroenterology practices, an endoscopic retrograde cholangiopancreatography (ERCP) is performed first to remove the common bile duct stones before the laparoscopic cholecystectomy.
As a referral center for complex biliary surgery problems in South Florida, Dr. Sucandy and his team are very familiar with these rather special circumstances. A 55-year-old man presented with large migrated stones within his common bile duct and the attempts for ERCP have failed. In this situation, a robotic cholecystectomy with common bile duct exploration is necessary as the ultimate option.
Dr. Sucandy and his team performed a common bile duct exploration to remove multiple large stones from the distal common bile duct. A small camera called SpyglassTM was also inserted into the upper and lower bile ducts to ensure the absence of stones. Once the stones had been completely cleared, the opening on the bile duct was then meticulously closed to avoid postoperative bile leakage which is a dreaded complication. This is the “Achilles tendon” of the operation where in the era of laparoscopic surgery, closure of the common bile duct is associated with a high rate of leak, bile peritonitis (bile spillage into the abdominal cavity) and later narrowing of the bile duct. Today, with the use of robotic systems by experienced surgeons such as Dr. Sucandy, this problem no longer constitutes a concern. This technique of common bile duct exploration requires a steep learning curve and it is generally not offered by community general surgeons. Dr. Sucandy as a robotic liver surgeon and robotic biliary surgeon offers this advanced operation on a routine basis.
The American College of Surgeons (ACS) decided to highlight the technical video of Dr. Sucandy and the team to be presented at the ACS Webinar 2 weeks ago. This education event was very well attended with more than 500 participants nationally. This was once the most well-attended webinar in the history of surgery. A healthy conversation and sharing of surgical techniques among participants were observed. In cases of complex biliary surgery, it is crucial to seek an expert surgeon like Dr. Sucandy who has a comprehensive clinical team of gastroenterologists, interventional radiologists, and surgeons with lots of experience in the treatment of this disease.
