Introduction: Symptomatic cholelithiasis is usually a relative indication for cholecystectomy. When acute cholecystitis with potential liver abscess develops in a post-kidney transplant (KT) patient the consequences can be catastrophic, with high risk of graft loss. We report here a case series of 16 patients submitted to robotic-assisted cholecystectomies post-KT due to findings of gallstones or concerning polyps.

Methods: Prospectively collected data of patients submitted to robotic-assisted cholecystectomies at the Jackson Memorial Hospital, University of Miami, Miami Transplant Institute, in the period of Aug-2021 to Mar-2022, during the first phase of implantation of the Transplant Robotic Program. Data relative to the pre-operative, intra-operative and post-operative periods were collected, including clinic-demographic characteristic of the patients, surgical metrics, and pathology findings. Continuous variables were analyzed with Student t-test, categorical variables were analyzed with chi-square test. A p-value of less than 0.05 was considered to be statistically significant.

Results: 16 patients were included, of those 10 (62.5%) were male. The median age was 57 years old (IQR 50-67.8). Of all cases analyzed, 10 (62.5%) were indicated for surgery based on symptomatic cholelithiasis only, without preoperative radiologic signs of chronic or acute cholecystitis. There were 2 (12.5%) of acute cholecystitis, 2 (12.5%) of chronic cholecystitis, and 2 (12.5%) of gallbladder suspicious polyps. Symptoms were vague and non-specific in 8/10 (80%) of the cases. The median intra-operative robotic console time was 30 min (IQR 23-49). 12 patients presented with intra-operative macroscopic acute/chronic cholecystitis. The median length of stay was 0.9 (IQR 0.9-1.1) days. There were no postoperative readmissions or complications associated to the procedure. The pathology impressively revealed chronic or acute cholecystitis in 15 (93.8%) patients, with no cases of malignancy. There was no statistically significant difference between the groups analyzed.

Conclusion: Immunocompromised patients may not present with classic clinical symptoms. Robotic-assisted cholecystectomy is a relatively simple procedure associated with minor risk of complications, and should be considered for more liberal indication in oligosymptomatic patients.