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Zhu et al. Mini-invasive Surg 2023;7:12 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.117

Case Report Open Access

Robotic-assisted approach for complex

cholecystectomies

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Gina Zhu , Kelli Ann Ifuku , Kimberly S. Kirkwood
Department of Surgery, University of California, Genentech Hall, San Francisco, CA 94158, USA.
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Both authors contributed equally.
Correspondence to: Dr. Kimberly S. Kirkwood, Department of Surgery, University of California, San Francisco, 600 16th
Street, Genentech Hall, S512F, San Francisco, CA 94143, USA. E-mail: Kim.kirkwood@ucsf.edu

How to cite this article: Zhu G, Ifuku KA, Kirkwood KS. Robotic-assisted approach for complex cholecystectomies. Mini-invasive
Surg 2023;7:12. https://dx.doi.org/10.20517/2574-1225.2022.117

Received: 17 Dec 2022 First Decision: 21 Feb 2023 Revised: 27 Mar 2023 Accepted: 31 Mar 2023 Published: 12 Apr 2023

Academic Editors: Giulio Belli, Zenichi Morise Copy Editor: Ke-Cui Yang Production Editor: Ke-Cui Yang

Abstract
Robotic approaches have facilitated the minimally invasive completion of increasingly complex surgical procedures.
In the management of the difficult gallbladder, we have found that the wristed instruments, three-dimensional
camera, the ability to use indocyanine green (ICG) with integrated fluorescent imaging, and ease of intracorporeal
suturing to be useful in tackling the challenges associated with complex benign gallbladder disease. We describe
the rationale and technical lessons learned during four cases of complex cholecystectomies that highlight the
management principles and technical advantages afforded by the use of the robotic-assisted laparoscopic (RAL)
approach. The cases include a subtotal fundus-first reconstituting cholecystectomy, subtotal fenestrating
cholecystectomy, a cholecystocolonic fistula managed by a RAL subtotal fenestrating cholecystectomy, and an
iatrogenic cholecystoduodenal fistula managed by RAL cholecystectomy. In each case, the operation was
performed safely without intraoperative injury or conversion to open, and three of the four patients were
discharged from the recovery room. In our view, these favorable outcomes were greatly facilitated by the robotic
platform. It is our intent to share adaptations and innovations that we found helpful to encourage other surgeons
with sufficient robotic experience to tackle complex gallbladder cases minimally invasively.

Keywords: Robotic-assisted laparoscopic cholecystectomy, indocyanine green, complex cholecystectomy

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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