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

Jun 10, 2024

Guest

Ben Vierra

Guest

In this engaging discussion, surgeons Andrew Wright, Nick Cetrulo, and Nicole White from UW Medical Center, alongside residents Paul Herman and Ben Vierra, dive deep into the evolution of cholecystectomy techniques. They explore the dramatic rise in robotic surgery and its implications for patient outcomes compared to traditional laparoscopic methods. The team examines the history of bile duct injuries and highlights ongoing efforts to minimize these risks. Insights into training challenges and the importance of surgeon experience add further depth to their analysis.

Ask episode

AI Snips

Chapters

Transcript

Episode notes

INSIGHT

Bile Duct Injury Causes

Bile duct injuries still occur despite preventative measures.
Most injuries stem from visual misperception, often unrecognized intraoperatively.

INSIGHT

Robotic vs. Laparoscopic Cholecystectomy Outcomes

A 2023 JAMA Surgery study revealed a higher bile duct injury rate in robotic versus laparoscopic cholecystectomies.
Robotic surgery also had increased biliary interventions and serious complications.

ANECDOTE

Diagnostic Challenges

Preoperative diagnoses can be misleading; seemingly simple biliary colic cases may turn complex intraoperatively.
Medicare data, lacking detailed operative reports, might misclassify some acute cholecystitis cases.

Get the Snipd Podcast app to discover more snips from this episode

Get the app

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/

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out our recent episodes here: https://app.behindtheknife.org/listen