A multi-centre, UK-based, cohort study assessing the role of robotic common bile duct exploration for complex choledocholithiasis

BACKGROUND: There is no consensus on the gold-standard treatment for choledocholithiasis. This retrospective multicentric cohort study aimed to assess the safety, efficacy, and role of robotic common bile duct exploration (RCBDE) in treating choledocholithiasis.

METHODS: All adult (≥18 years) consecutive patients undergoing RCBDE either alongside or following cholecystectomy between 2018 and 2024 were included. Primary outcome was success in stone clearance. Secondary outcomes included open conversion, length of hospital stay, post-operative complications and interventions, 30-day re-admission, and 90-day mortality rates.

RESULTS: A total of 102 consecutive RCBDEs were performed. Biliary access was transcholedochal in 86.3 % (88/102) and transcystic in 13.7 % (14/102). Stone clearance was achieved in 92.2 % (94/102) of cases, with a bile leak rate of 2.9 % (3/102), and an overall morbidity rate of 19.6 % (20/102), including 7.8 % (8/102) with Clavien-Dindo grade ≥3 complications. Overall conversion rate was 9.8 %, with significantly lower rates in single-stage procedures, where RCBDE was performed alongside cholecystectomy, compared to RCBDE alone, 1.4 % (1/73) vs 30.4 % (7/23), (P < 0.001), respectively.

CONCLUSION: This study highlights the high success rate in stone clearance and low bile leak rate associated with RCBDE. However, open conversion rate was significantly increased when RCBDE was performed following previous cholecystectomy.