A combined endoscopic and robotic approach for Mirizzi syndrome: the short- and long-term outcomes

Abstract

Aims: We present the technique of a combined endoscopic and robotic approach for Mirizzi syndrome (MS) and report the short- and long-term results.

Methods: Between July 2012 and August 2020, all patients with suspected MS underwent endoscopic retrograde cholangiopancreatography (ERCP) for diagnostic confirmation and placement of the biliary stent. Subtotal cholecystectomy was then performed with the assistance of a surgical robot. The common bile duct was closed with a cuff of the gallbladder over a biliary stent. ERCP was repeated 6-8 weeks after surgery to remove the biliary stent and confirm the patency of common bile duct. The operative outcomes and long-term results were prospectively collected.

Results: Twenty-two patients (10 males and 12 females) were included in the study. All patients underwent the planned robotic subtotal cholecystectomy and pre- and postoperative ERCP. The median age was 65.5 years (range 16-89 years). The median operative time was 212.5 min (range 125-510 min), and the median blood loss was 35 mL (range 7-700 mL). The median postoperative hospital stay was four days (range 3-15 days). Four patients (18.2%) developed postoperative complications including two intra-abdominal collections (9.1%), one wound infection (4.5%), and one atrial fibrillation with pneumonia (4.5%). The last patient also represented the only operative mortality. The median follow-up was 45.6 months; none developed recurrent cholangitis or jaundice, but one patient (4.5%) had a recurrent common bile duct stone which was successfully removed by ERCP.

Conclusion: The proposed combined endoscopic and robotic approach can provide favorable short- and long-term outcomes for patients with MS.

Keywords

Mirizzi syndrome (MS) / endoscopic retrograde cholangiopancreatography (ERCP) / robotic cholecystectomy / robotic exploration of common bile duct

References

[1] Mirizzi PL.Sindrome del conducto hepatico.J Int Chir1948;8:731-7

[2] Abou-Saif A.Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus.Am J Gastroenterol2002;97:249-54

[3] Kok KY,Ngoi SS.Management of Mirizzi’s syndrome in the laparoscopic era.Surg Endosc1998;12:1242-4

[4] Erben Y,Donohue JM.Diagnosis and treatment of Mirizzi syndrome: 23-year Mayo Clinic experience.J Am Coll Surg2011;213:114-9; discussion 120

[5] Antoniou SA,Makridis C.Laparoscopic treatment of Mirizzi syndrome: a systematic review.Surg Endosc2010;24:33-9

[6] Lee KF,Ma KW.A minimally invasive strategy for Mirizzi syndrome: the combined endoscopic and robotic approach.Surg Endosc2014;28:2690-4

[7] McSherry CK,Virshup M.The Mirizzi syndrome: suggested classification and surgical therapy.Surg Gastroenterol1982;1:219-25

[8] Csendes A,Burdiles P,Nava O.Mirizzi syndrome and cholecystobiliary fistula: a unifying classification.Br J Surg1989;76:1139-43

[9] Beltran MA,Cruces KS.The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification.World J Surg2008;32:2237-43

[10] Beltrán MA.Mirizzi syndrome: history, current knowledge and proposal of a simplified classification.World J Gastroenterol2012;18:4639-50 PMCID:PMC3442202

[11] Dindo D,Clavien PA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg2004;240:205-13 PMCID:PMC1360123

[12] Yeh CN,Chen MF.Laparoscopic treatment for Mirizzi syndrome.Surg Endosc2003;17:1573-8

[13] Kwon AH.Preoperative diagnosis and efficacy of laparoscopic procedures in the treatment of Mirizzi syndrome.J Am Coll Surg2007;204:409-15

[14] Cui Y,Li Z.Appraisal of diagnosis and surgical approach for Mirizzi syndrome.ANZ J Surg2012;82:708-13

[15] Senra F,Acosta A.Laparoscopic management of type II Mirizzi syndrome.Surg Endosc2020;34:2303-12 PMCID:PMC7113232

[16] Hazzan D,Reissman P,Shiloni E.Combined endoscopic and surgical management of Mirizzi syndrome.Surg Endosc1999;13:618-20

[17] Chowbey PK,Mann V.The management of Mirizzi syndrome in the laparoscopic era.Surg Laparosc Endosc Percutan Tech2000;10:11-4

[18] Zheng M,Qin M.Combined laparoscopic and endoscopic treatment for Mirizzi syndrome.Hepatogastroenterology2011;58:1099-105

[19] Yuan H,Sun X.A minimally invasive strategy for Mirizzi syndrome type II: combined endoscopic with laparoscopic approach.Surg Laparosc Endosc Percutan Tech2016;26:248-52

[20] Magge D,Novak S.Performing the difficult cholecystectomy using combined endoscopic and robotic techniques: how i do it.J Gastrointest Surg2017;21:583-9

[21] Dip F,Sarotto L.Randomized trial of near-infrared incisionless fluorescent cholangiography.Ann Surg2019;270:992-9

[22] Bhandari S,Sharma A.Usefulness of single-operator cholangioscopy-guided laser lithotripsy in patients with Mirizzi syndrome and cystic duct stones: experience at a tertiary care center.Gastrointest Endosc2016;84:56-61

[23] Chen H,Khu M.Current trends in the management of Mirizzi Syndrome: a review of literature.Medicine (Baltimore)2018;97:e9691 PMCID:PMC5794376