Complications - Cholecystectomy, Robotic-Assisted

  1. Intraoperative Complications and Management

    • Liver Capsule Tear (including the area of the ligamentum teres hepatis):
      •  Manage with fibrin glue or fibrin-coated collagen fleece
    • Gallbladder Hydrops or Severe Wall Thickening (Difficult Handling):
      • Initiate cholecystectomy by puncturing the gallbladder
    • Accidental Gallbladder Perforation:
      • Aspirate bile and irrigate the surgical field
      • Administer antibiotics
      • Close the perforation with a clip, ligature, or grasping forceps
      • Check for and recover any lost stones
    • Lost Stones or Clips:
      • Search for and retrieve lost items, possibly using a retrieval bag
    • Injury or Partial Ligation of the Common Bile Duct (DHC):
      • Remove all clips
      • Redissect to expose the confluence and DHC
      • Place the first clip close to the gallbladder neck
      • Insert a drain
      • If DHC is injured, suture with PDS 5-0. Consider conversion or intra-/postoperative ERCP with stent placement
    • Transection of the Common Hepatic Duct (DHC):
      • Perform laparotomy
      • Attempt reanastomosis or create a biliodigestive anastomosis
    • Uncertain Clip Closure:
      • Use a Roeder loop for secure closure
      • Guide the pre-fabricated loop with forceps, grasp the cystic stump, place the loop near the base, and cut it 5-7 mm above the knot
    • Bleeding in the Common Hepatic Duct Bifurcation Area:
      • Use careful bipolar high-frequency (HF) coagulation
      • Compress and control bleeding with fibrin-coated collagen fleece
      • For larger vessels: Apply clips or perform ligation
      • For uncontrolled laparoscopic bleeding: Convert to laparotomy
    • Bleeding from the Cystic Artery:
      • Suction blood and position the suction tip at the perforation site
      • Place a blind clip if the bleeding site is unclear, then aspirate and rinse to identify the site
      • Apply a new targeted clip and remove the old one
      • Ensure definitive identification of the cystic artery
      • If identified, circumferentially dissect the vessel and place clips proximally and distally
    • Bleeding from the Liver Bed:
      • Use bipolar HF coagulation, compression, or ligation sutures
      • Place a hemostatic agent (e.g., fibrin-coated collagen fleece), possibly combined with fibrin glue
    • Diaphragm Perforation:
      • Repair with sutures
      • If necessary, perform laparotomy and place a Bülow drain
Postoperative Complications

Biliary leakage: Biliary SecretionIf bile secretion is observed from the subhepatic drain or an inc

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