AN ANALYSIS OF IATROGENIC BILIARY INJURY AFTER ROBOTIC CHOLECYSTECTOMY: CURRENT DATA AND FUTURE CONSIDERATIONS

Abstract

Objective:
To determine the incidence, classification, and associated risk factors of iatrogenic biliary injury (IBI) following robotic cholecystectomy (RC) and to evaluate current preventive strategies and future considerations for improving patient safety.

Study Design: Descriptive cross-sectional research.

Place and Duration of Study: Jinnah postgraduate medical centre (JPMC) Department of General Surgery, Karachi, during a six months period following CPSP and IRB approval.

Methodology: Non-probability consecutive sampling was used to include 43 patients undergoing RC. Patients who had undergone prior surgery in the biliary tract or had known anomalies in the biliary or those patients who had undergone a conversion surgery prior to Calot triangle dissection were not included. The data on the demographics, comorbidity, intraoperative report, Critical View of Safety (CVS) report, indocyanine green (ICG) fluorescence application, and IBI prevalence were gathered in the prospective manner. The system of classifying injuries was the StrasbergBismuth system. They were analyzed in SPSS v26, using descriptive statistics and stratification of confounders. Figure 1: The gender structure of patients in the operation of robotic cholecystectomy (n = 43).

 Results: The mean age was 45.2 ± 12.3 years (range: 21–68). There were 18 males (41.9%) and 25 females (58.1%). IBI was present in 2 patients (4.7%), both of the Strasberg Bismuth type E (E1 and E2). Injured cases had longer mean operative time. All the IBIs were addressed by converting to open operations and were sent to hepatopancreatobiliary services to have their repair done.

Conclusion: IBI is a major complication of RC especially in the learning curve and in complicated cases. Close compliance to the principles of CVS, proper use of the ICG fluorescence, organized credentialing, and early referral to the specialized centres are required to minimize morbidity and enhance the outcomes.