Robotic cholecystectomy with cholecysto-duodenal fistula division

Cholecysto-duodenal fistula (CDF) is a rare complication of chronic calculous cholecystitis. Due to advancements in minimally invasive techniques, a paradigm shift has occurred from the traditional open surgery to laparoscopic repair, but only one case report highlights robotic repair. In this article, we report a case of CDF management using a robotic approach. A woman in her 50s with a history of laparoscopic Roux-en-Y gastric bypass surgery presented with postprandial right upper quadrant abdominal pain, associated with diarrhoea. Abdominal ultrasound showed cholelithiasis with dilated common bile duct, which did not contain gallstones based on magnetic resonance cholangiopancreatography (MRCP). She underwent robotic-assisted laparoscopic cholecystectomy, where she was found to have a CDF, which was divided robotically. The patient had an uneventful recovery. This case report discusses the advantage of the robot's enhanced visualisation of dense adhesions in three dimensions, eliminating the need for conversion to open surgery.