Robot-assisted minimally invasive common bile duct exploration: a Canadian first.

An 84-year-old woman with significant medical comorbidities presented with obstructive jaundice and radiographic evidence of choledocholithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) was attempted but was unsuccessful owing to a duodenal diverticulum. The patient was referred for laparoscopic common bile duct exploration. After consultation by the Minimally Invasive and Robotic Surgery service, it was determined that, with a common duct stone measuring 2 cm in greatest dimension, a laparoscopic transcystic approach would not be feasible. A pilot experience of 18 robot-assisted cholecystectomies had been completed, so we obtained consent for a da Vinci–assisted common bile duct exploration. The surgical procedure was performed successfully. Five operating ports were used: a 12-mm camera port, two 8mm da Vinci ports, a 12-mm accessory and retracting port and a 5-mm port for cholangiography and choledochoscopy. After dissecting the Triangle of Calot, we carried out a transcystic cholangiography under fluoroscopy. This demonstrated several biliary calculi. The porta hepatis was exposed, and a 2-cm anterior choledochotomy was performed. Choledochoscopy and basket extraction of the multiple calculi and sludge were required (Fig. 1). We performed a full choledochoscopy from the ampulla of Vater to Case Note Note de cas