Using da Vinci SP System for Patients With Cholelithiasis and Choledocholithiasis

Inclusion Criteria:

1. Age 20 years or more

2. Symptomatic cholelithiasis with or without choledocholithiasis, symptomatic chroniccholecystitis with or without biliary tract injury or stricture

3. Indication of cholecystectomy with or without common bile duct exploration anddeemed feasible for robotic surgery

4. Patient not feasible or have failed stone extraction or intervention forcholedocholithiasis by endoscopic retrograde cholangiopancreatography for patientswith choledocholithiasis could be included

5. ASA physical status classification 1-2 and adequate organ function

6. Patients willing and able to comply with study protocol requirements and follow-up

7. Patients who are taking anti-platelet or anti-coagulation medications are eligiblefor this trial, but the associated agents should be discontinued 5 days prior to theoperation day. Patients who are taking Wafarin should be admitted two days earlierfor bridging to Heparin. Other medications for underlying diseases can be taken asusual.

8. With informed consent

Exclusion Criteria:

1. Severe acute cholecystitis

2. Suspected biliary tract cancer or untreated biliary tract cancer

3. BMI ≥35 or BMI <18.5

4. Unable to tolerate robotic surgery position

5. Severe adhesion due to prior abdominopelvic surgery

6. Prior major upper abdominal surgery judged by the investigator as not feasible forrobotic surgery

7. Active infectious disease

8. Severe concomitant illness that drastically shortens life expectancy or increasesrisk of therapeutic interventions, such as: severe heart disease (NYHA functionalclass III-IV) or severe lung disease (GOLD Group C-D)

9. Cannot follow trial-required procedures

10. Concomitant systemic or pelvic disease that increases the risk of surgery

11. Patients with coagulopathy

12. Emergency surgery