Robotic-assisted laparoscopic cholecystojejunostomy.
Surgical laparoscopic robotic systems have been developed to transfer time-consuming, repetitive tasks from human to robot, thus increasing safety and improving surgical outcome. Laparoscopic cholecystojejunostomy for unresectable pancreatic cancer has become widely accepted. The main manipulation of this operation is suturing, which could possibly be done with robotic assistance. The aim of this study was to assess the feasibility and the technical aspects of robotic-assisted laparoscopic cholecystojejunostomy. Sixteen pigs were divided into two groups of eight. Robotic-assisted laparoscopic cholecystojejunostomy (Roux-Y anastomosis) was performed in one group of animals (Group RLC). The second group was used as control and underwent a laparoscopic cholecystojejunostomy using the ordinary laparoscopic instruments, except with robotic camera control (Group LC). Laparotomy and fluoroscopic examination were performed postoperatively. Animals in both groups tolerated the operations well. There was no significant difference in set-up time between groups. The operative time and the time for completing the two anastomoses were significantly longer in the RLC group. There was no leakage after anastomoses in any animal, as confirmed by laparotomy and fluoroscopy. Robotic-assisted laparoscopic cholecystojejunostomy is technically feasible. Stable images and comfortable manipulation can be obtained using this technique. One or two surgeons can perform this operation, assisted by the robotic system. The main disadvantages are longer operative time and the use of expensive devices. With improvements in robotic instruments and techniques, the operative time will be decreased and the technology could become widely accepted.