title: A minimally invasive strategy for Mirizzi syndrome: the combined endoscopic and robotic approach.
abstract: BACKGROUND
  Mirizzi syndrome (MS) is a rare complication of gallstone disease. Despite the fact that successful laparoscopic treatments have been reported, open surgery remains the gold standard approach for this disease due to technical difficulties involved.
  
  
  METHODS
  A minimally invasive strategy combining endoscopic retrograde cholangiopancreatography (ERCP) and robotic surgery for the management of MS was implemented in early 2012. This consisted of a preoperative ERCP for definitive diagnosis and endoscopic stent insertion. Robotic surgical approach was used during operation to facilitate gall bladder removal and suture of defect over common duct. ERCP was repeated postoperatively for stent removal. Patient demographics and treatment outcomes were collected prospectively. A historical cohort of patients with MS who underwent conventional surgery between 1999 and 2011 was identified for comparison of treatment outcomes.
  
  
  RESULTS
  Five patients with MS were managed with this strategy. Robotic subtotal cholecystectomy was successfully performed in all the patients without conversion or morbidity. When compared with a historical cohort of 17 patients who underwent surgery for MS, this group of patients had significantly less conversion and shorter hospital stay though the operation time was longer. It also showed less blood loss and less postoperative complications but these were not statistically significant.
  
  
  CONCLUSIONS
  Mirizzi syndrome can be effectively managed with a minimally invasive approach by adopting a robot-assisted surgery together with a planned pre- and postoperative ERCP.
authors.affiliation: Department of Surgery, Prince of Wales Hospital, 30-32, Ngan Shing Street, Shatin, NT, Hong Kong, leekf@surgery.cuhk.edu.hk.
authors.forename: Kit-fai
authors.initials: KF
authors.lastname: Lee
authors.forename: Ching-ning
authors.initials: CN
authors.lastname: Chong
authors.forename: Ka-wing
authors.initials: KW
authors.lastname: Ma
authors.forename: Eric
authors.initials: E
authors.lastname: Cheung
authors.forename: John
authors.initials: J
authors.lastname: Wong
authors.forename: Sunny
authors.initials: S
authors.lastname: Cheung
authors.forename: Paul
authors.initials: P
authors.lastname: Lai
mesh_terms: D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D002763:Cholecystectomy / Q000379:methods*; D002769:Cholelithiasis / Q000150:complications; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D057792:Mirizzi Syndrome / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D015607:Stents; D016896:Treatment Outcome
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