Robotic Completion Cholecystectomy after Prior Subtotal Reconstituting Cholecystectomy

Joseph Greene, MD, MBA

Product Details
Product ID: ACS-6126
Year Produced: 2020
Length: 10 min.


We present the case of a patient with recurrent acute on chronic calculous cholecystitis, who is 10 years status post a prior laparoscopic converted to open subtotal reconstituting cholecystectomy for acute calculous cholecystitis. Consistent with the literature, these patients are at higher risk for recurrent episodes of cholecystitis. In planning the operation, the Intuitive DaVinci surgical robot was employed for the completion cholecystectomy for its precision in dissection and ability to perform intraoperative indocyanine green fluorescence cholangiography for effective identification of the remnant gallbladder, duodenum, and biliary ductal anatomy. To our knowledge, this is the first documented report of deploying these technologies for the purpose of completion cholecystectomy. This video also highlights the importance of completion radiographic cholangiography during minimally invasive cholecystectomy. The initial radiographic cholangiogram demonstrates contrast only emptying through the common bile duct into the duodenum without retrograde filling of the hepatic ducts. The cholangiogram catheter was repositioned, morphine administered, and the patient was placed in Trendelenburg position for a subsequent cholangiogram. Subsequent cholangiography demonstrated satisfactory filling of the hepatic ducts. This lesson demonstrates important principles in acquisition of a satisfactory cholangiogram and measures which can be undertaken intraoperatively to promote obtaining a completion cholangiogram.