1. Introduction

2. Surgical Approach and Placement of Ports

3. Robot Docking

4. Exposure

5. Critical View of Safety Dissection

6. Clipping and Division of Cystic Duct and Artery

7. Removal of the Gallbladder from the Bed of the Liver

8. Hemostasis, Cleanup, and Robot Undocking

a. TAP Block

b. Removal of Specimen

9. Closure

10. Post-op Remarks

Acute cholecystitis occurs when gallstones become impacted in the neck of the gallbladder or cystic duct in approximately 90–95% of cases. Symptoms may include acute right upper quadrant pain, fever, nausea, and emesis often associated with eating. Acute cholecystitis generally has imaging findings of gallbladder wall thickening, edema, gallbladder distension, pericholecystic fluid, and positive sonographic Murphy sign. However, acute cholecystitis is largely a clinical diagnosis of persistent right upper quadrant (RUQ) pain and associated tenderness on palpation of the RUQ in the setting of gallstones. The standard treatment is a cholecystectomy to prevent recurrent cholecystitis or sequelae of gallstones. Timing of the cholecystectomy is dependent on length of symptoms, which reflect the degree of inflammation.  Here we present the case of a 74-year-old male who presented with six days of acute cholecystitis symptoms who was initially managed with antibiotics. After improvement of his pain and no systemic symptoms of infection, he underwent an interval robotic cholecystectomy. This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.

Watch this full-length narrated surgical video of a robotic-assisted laparoscopic interval cholecystectomy performed by Dr. Charu Paranjape, the Chief of General and Acute Care Surgery at Newton-Wellesley Hospital.

Newton-Wellesley Hospital