What are the post-operative care recommendations for an adult patient with acute cholecystitis who underwent robot-assisted laparoscopic cholecystectomy with Indocyanine Green (ICG)?

Post-Operative Care After Robot-Assisted Laparoscopic Cholecystectomy for Acute Cholecystitis

For uncomplicated acute cholecystitis with complete source control achieved during surgery, no postoperative antimicrobial therapy is necessary. 1

Immediate Post-Operative Management

Antimicrobial Therapy

• Discontinue antibiotics immediately after surgery when source control is complete and the patient has uncomplicated cholecystitis, as demonstrated in this case with successful removal of the gallbladder and achievement of critical view of safety 1
• The presence of stones packed within the cystic duct does not change this recommendation, as the infected source has been removed 1

Expected Recovery Timeline

• Hospital discharge within 24 hours is typical for uncomplicated laparoscopic cholecystectomy 2
• Return to normal activity within 7 days post-operatively 2, 3
• Return to work within 2 weeks for most patients 3

Monitoring and Complications Surveillance

Key Post-Operative Assessments

• Monitor for bile leak given the stones packed in the cystic duct noted intraoperatively, though the operative note documents no bleeding or bile in the gallbladder fossa after removal 1
• Assess for wound infection, which occurs less frequently with laparoscopic versus open approach 1
• Evaluate for pneumonia, another complication reduced by the laparoscopic technique 1

Warning Signs Requiring Immediate Evaluation

• Persistent fever or new-onset fever after initial post-operative period 1
• Increasing abdominal pain or peritoneal signs 1
• Jaundice or dark urine suggesting bile duct injury or retained stones 3
• Persistent drainage from port sites 1

ICG-Specific Considerations

Post-Operative Implications

• ICG fluorescence imaging aids intraoperative identification of ductal structures but requires no specific post-operative management 4
• The use of ICG to confirm anatomy reduces risk of bile duct injury, which when it occurs is only identified intraoperatively in one-third to one-half of cases 2
• No additional monitoring is required specifically for ICG use, as it is rapidly cleared from the body 4

Robot-Assisted Technique Considerations

Recovery Advantages

• Robot-assisted laparoscopic cholecystectomy demonstrates similar safety and recovery profiles to conventional laparoscopy 5, 6
• The robotic approach in acute cholecystitis cases shows no increase in complications compared to standard laparoscopy 7, 6
• Median operative times and patient recovery are comparable to conventional techniques 5

Diet and Activity Progression

Early Post-Operative Period

• Advance diet as tolerated once the patient is fully awake and has no nausea 2
• Most patients tolerate regular diet at discharge 5
• No specific dietary restrictions are required after cholecystectomy for acute cholecystitis 2

Activity Restrictions

• Avoid heavy lifting (>10-15 pounds) for 2 weeks to allow port site healing, particularly the umbilical port where fascial closure was performed 2
• Resume light activities immediately as tolerated 2
• Full activity typically achieved within 7 days 3

Follow-Up Planning

Outpatient Management

• Routine post-operative visit at 2 weeks to assess wound healing and ensure resolution of symptoms 2
• No routine imaging is required in uncomplicated cases 1
• Pathology review of gallbladder specimen to confirm acute cholecystitis and rule out unexpected findings 1

Critical Pitfalls to Avoid

Common Post-Operative Errors

• Do not continue antibiotics "to complete a course" when source control is achieved—this increases antimicrobial resistance without benefit 1
• Do not dismiss new-onset jaundice as normal post-operative course—this may indicate bile duct injury or retained common bile duct stones requiring urgent evaluation 3
• Do not attribute persistent right upper quadrant pain solely to surgical trauma—consider bile leak, retained stones, or other complications 1

High-Risk Patient Considerations

• This patient's age and acute cholecystitis place them at higher baseline risk, though the successful laparoscopic completion is favorable 1
• Monitor more closely for cardiovascular and pulmonary complications in the immediate post-operative period, as these occur in 6-9% of acute cholecystitis cases 1