Page 23 - Journal of WALS

WJOLS

Role of Robotic Surgery in the Treatment of Mirizzi Syndrome

Conversion or an open operation allows the use of danger of injury to biliary structures the more than human
proprioception or the touch of the surgeon’s hand and is eye magnification of the operation field and the highly
generally accepted as a way to improve the safety of any skilled, refined and controlled movement of the surgical
operation, especially one in which severe inflammation is robot is actually what is required to make the difference.
present. To replicate this, hand-assisted laparoscopic surgery The drawback of robotic cholecystectomy is the extra time
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for MS has been advocated. However, MS open surgery is taken to prepare the patient and docking, however, surgery
associated with significant short- and long-term morbidity, once started does not take much time.
and a difficult operation is not necessarily easier or safer
when performed open. 10,11 With the recent advanced ACKNOWLEDGMENTS
preoperative imaging, ERCP, current intraoperative robotic We wouid like to express our gratitude to Professor
fluorescence imaging-compatible and sensors; robotics are Augustine Agbakwuru, Professor Lawal, Dr Eziyi,
now very relevant and useful in stone disease. Dr Arowolo, Dr Adewale Adisa and Dr Etonyeaku Chuks
ERCP is used to make the diagnosis and insert a stent to Amara (Obafemi Awolowo University Teaching Hospital
alleviate the jaundice and allow planning of an elective Ile-ife, Osun state, Nigeria). They have been relevant to my
operation. Stenting usually overcomes the resistance of the development.
choledochal sphincter and this simplify and improves the Our sincere appreciation to Dr Omotoso (CMD Federal
safety of the operation. If ERCP is to be used as definitive Medical centre Owo, Ondo state Nigeria) and his entire
treatment, sophisticated techniques may be needed for these management team.
cases, including the use of a ‘mother and baby scope’ and We are very grateful to Baba Akinseye, Barrister Ade
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electrohydraulic or laser lithotripsy. Any of these Akinbosade and Chief Sakara (lgsc Akure, Ondo state,
sophisticated ERCP techniques would require an endoscopic Nigeria) for their support and encouragement in pursuit of
sphincterotomy. Since, the GB is to be removed anyway, it this training. We would also like to thank Chief Wale
is preferable to leave the choledochal sphincter intact to Ogumade, Mr Akintelure, Pastor Arioloye lgsc Okitipupa,
avoid long-term risk of choledocholithiasis from a colonized Ondo state, Nigeria for their understanding.
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biliary tract and papillary stenosis. When it is not possible This work would not have been possible without the
to stent the obstruction from below, a percutaneous inspiration of our Professor Dr RK Mishra, Dr Chowhan
transhepatic approach could be used. This would be and also Mr Ranjan. Dr Mishra has broadened my mentality
relatively straightforward as the hepatic ducts may be dilated and will continue to be my father in laparoscopy and
and would be a good strategy in patients unfit for surgery. 14 robotics.
There is an estimated five-fold risk of GB malignancy I would like to express my special thanks to my family,
in MS compared with that in uncomplicated gallstone my parents, Chief Sam Obonna (iyierioba), my mother,
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disease. Prasad et al found 5.3% of patients with MS Chief Mrs CC Obonna (mmaezi) and all my brothers, sisters
had GB cancer compared with 1% in non-MS cases, and and in-laws. I would like to give my special thanks to my
most were diagnosed on histology after cholecystectomy. wife Vivian and children Martin, Chummy, Ezinne, Blossom
If the patient is fit for surgery, the optimal management of and Wilson whose patience and love enabled me to complete
MS must be complete removal of the GB with a wedge this oversea training.
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resection of the liver. This is most possible in robotic
surgery with ultrasound dissector because it possesses REFERENCES
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pinpoint dissection strategy. 731-33.
2. Waisberg J, Corona A, Luppinacci RA. Benign obstruction of
the common hepatic duct: Diagnosis and operative management.
CONCLUSION
Arq Gastroenterol 2005;42:13-18.
The da Vinci surgical robot has simplified what could have 3. Yeh, et al. Laparoscopic treatment for Mirrizi syndrome. Surg
Endosc 2003;17:1573-78.
been a complex surgery because of its model technology. 4. Chan CY, Liau KH, Ho CK. Mirrizi syndrom: A diagnostic and
In combination with endoscopic stenting, robotics are useful operative challenge. Surgeon 2003;1:273-78.
in the operation of patients with MS types 1 and 2. Stenting 5. Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirrizi
overcomes the resistance of the choledochal sphincter and syndrom and cholecystobilliary fistula: A unifying classification.
Br J Surg 2005;76(11):1139-43.
even if accurate closure of the opening in a friable and 6. Nagokowa T, Ohta. A new classification of Mirrizi syndrome
inflamed duct is not possible it should avoid the from a diagnostic and therapeutic viewpoint. Hepatogastro-
development of a significant biliary fistula. When there is enterology 1997;44:63-67.
World Journal of Laparoscopic Surgery, May-August 2012;5(2):80-84 83