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Surg Endosc (2014) 28:26902694 DOI 10.1007/s00464-014-3529-3
A minimally invasive strategy for Mirizzi syndrome: the combined endoscopic and robotic approach
Kit-fai Lee Ching-ning Chong Ka-wing Ma
Eric Cheung John Wong Sunny Cheung
Paul Lai
Received: 12 November 2013 / Accepted: 27 March 2014 / Published online: 16 April 2014 Springer Science+Business Media New York 2014
AbstractBackground 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 difculties 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 denitive 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 identied 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 signicantly 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 signicant. Conclusion 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.
Keywords Mirizzi syndrome ERCP Robotic surgery
Cholecystectomy
Mirizzi Syndrome (MS) is a rare complication of gallstone disease in which the common hepatic duct is obstructed by a stone impacted at Hartmanns pouch or cystic duct [1]. It is commonly classied as McSherry Type I when there is external compression only and Type II if a stula is formed between gall bladder and common duct due to inammation and erosion by the impacted stone [2]. Its incidence was reported between 0.06 and 5.7% [3, 4]. Difculty in management of MS lies on inadequate pre-operative diagnosis and...