Robotic multiport versus robotic single-site cholecystectomy: a retrospective single-centre experience of 142 cases

Abstract

Robotic cholecystectomy with the da Vinci Xi® system (Intuitive Surgical, Sunnyvale, CA, USA) can be performed either as a multiport or a single-incision procedure with the da Vinci Single-Site® platform. The value of robotic single-site cholecystectomy is still under debate. The aim of this study was to compare perioperative measures and postoperative outcomes of both robotic assisted approaches. 142 patients with benign gallbladder disease underwent da Vinci multiport (DVMPC; n = 111) or da Vinci Single-Site® cholecystectomy (DVSSC; n = 31) in our institution between October 2015–December 2018. Patient demographics and characteristics, perioperative measures, complications and outcomes were retrospectively analysed. Patients with DVSSC had a significant lower BMI an were younger compared to DVMPC patients (BMI: 25.2 versus 28.1, p = 0.004; age: 44.5 versus 54.2 years, p = 0.007). Operative time was longer in the DVSSC group (84.9 versus 69.9 minutes, p = 0.007). In the DVSSC group there were significantly more superficial surgical site infections (16.6 versus 3.6%, p = 0.024), more overall complications according to Clavien-Dindo (29.0 versus 9.9%, p = 0.016), and more pain on postoperative day 3 (numeric rating scale, 1.3 versus 0.4, p = 0.026). In both groups there were no injuries of hepatic hilar structures such as the common bile duct or of the right hepatic artery. DVSSC could be performed safely even in patients with acute cholecystitis and previous abdominal surgery. However, the da Vinci Single-Site® approach for cholecystectomy should not be considered as the standard of care procedure for benign gallbladder disease, due to a higher incidence of superficial surgical site infections, more overall complications and more postoperative pain compared to DVMPC.