Robot-assisted Laparoscopic Cholecystectomy Research Articles

Robotic versus Laparoscopic Cholecystectomy: Case-Control Outcome Analysis and Surgical Resident Training Implications.

BackgroundThe robotic approach in surgery is becoming more widely used in many subspecialties. Robot-assisted laparoscopic procedures provide potential improvements in clinical outcomes due to improved visualization and enhanced surgical ergonomics. In this study, we measured and compared outcomes of robot-assisted laparoscopic cholecystectomy with the conventional laparoscopic technique, as well as the implications for the training of surgical residents.MethodWe compared a total of 244 patients undergoing minimally invasive cholecystectomies performed by one surgeon between July 2013 and June 2016 examining relevant clinical outcomes including operative room (OR) time, length of hospital stay (LOS), readmission to the hospital, post-operative emergency department (ED) visits, and post-operative pain between laparoscopic single-incision cholecystectomy and robot-assisted laparoscopic cholecystectomy. A chi-square test and Student’s t-test were used to compare these variables between the two groups. Propensity score matching (PSM) was used using gender, age, and body mass index (BMI) as variables.ResultsFrom the total number of procedures of 244, 144 were included in the laparoscopic group and 100 in the robot-assisted group. The robot-assisted patients had a shorter post-operative LOS (mean: 0.8 vs. 1.6 days; p = 0.002). There was no significant difference in the OR time (mean: 64.8 vs. 65.0 minutes; p = 0.945), readmissions (4.0% vs. 3.5%; p = 0.830), post-operative ED visits (7.0% vs. 7.6%; p = 0.851), or post-operative pain (13.0% vs. 21.3%; p= 0.137). Robotic cholecystectomy patients were younger (mean: 46 vs. 52 years; p = 0.023) and had lower BMIs (mean: 31 vs. 33; p = 0.038). Because of these differences, we compared the two groups using PSM that confirmed the shorter LOS in the robotic group (mean: 0.9 vs. 1.9; p = 0.009).ConclusionsThese results demonstrate that robotic cholecystectomies can reduce LOS for patients undergoing laparoscopic cholecystectomy, without increasing OR time. Increased surgeon experience with robotic procedures and improved OR efficiency will allow greater opportunities for resident participation. Robotic training curricula need to be employed and objectively evaluated to improve surgical resident skill acquisition and provide earlier and progressive clinical participation in robotic procedures.

Initial Japanese Experience of Laparoscopic Cholecystectomy Using a New Robot-Assisted System

The object of this paper is to clarify the feasibility and safety of robot-assisted laparoscopic cholecystectomy. Acute or chronic cholecystitis is the most common disease in patients, caused by cholecystolithiasis. Minimally invasive laparoscopic surgery is often performed for treatment of cholelithiasis. We performed robot-assisted laparoscopic cholecystectomy for the treatment of 5 patients with cholecystolithiasis. The patient underwent laparoscopic cholecystectomy using the ViKY Endo-Control System (ViKY, EndoControl, Grenoble, France). The robot-controlled laparoscopic holder was placed at the right axilla. The laparoscopic operation was performed via conventional 4-port access using the ViKY system with voice activation. All patients were treated successfully by this robot-assisted laparoscopic procedure, without any complications. Mean docking time using the ViKY was 16 minutes, mean resection time of the gallbladder was 62.2 minutes, operative time was 94.6 minutes, and the mean amount of the blood loss was minimal. Our initial experience demonstrated that robot-assisted laparoscopy was feasible and safe in patients with cholecystolithiasis, providing patient advantages. We also discuss the advantages and disadvantages of robot-assisted laparoscopic surgery.

Relax, It's Just Laparoscopy! A Prospective Randomized Trial on Heart Rate Variability of the Surgeon in Robot-Assisted versus Conventional Laparoscopic Cholecystectomy

Background: Laparoscopic surgery might be beneficial for the patient, but it imposes increased physical and mental strain on the surgeon. Robot-assisted laparoscopic surgery addresses some of the laparoscopic drawbacks and may potentially reduce mental strain. This could reduce the risk of surgeon's fatigue, mishaps and strain-induced illnesses, which may eventually improve the safety of laparoscopic surgical procedures. Methods: To test this hypothesis, a randomized study was performed, comparing both heart rate and heart rate variability (HRV) of the surgeon as a measure of total and mental strain, respectively, during conventional and robot-assisted laparoscopic cholecystectomy. Results: Both heart rate and HRV (the low-frequency band/high-frequency band ratio) were significantly decreased when using robotic assistance. Conclusions: These data suggest the use of the daVinci® Surgical System leads to less physical and mental strain of the surgeon during surgery. However, assessing mental strain by means of HRV is cumbersome since there is no clear cutoff point or scale for maximum tolerated strain levels and its related effects on surgeon's health.

The case for conventional laparoscopic sacrocolpopexy

Paraiso et al. found no difference in anatomic or functional outcomes at 6 months postoperatively, length of hospital stay, or pain medication requirements after randomizing 67 patients with post hysterectomy vaginal vault prolapse to receive conventional versus robot-assisted laparoscopic sacrocolpopexy (RALSC). They did find greater postoperative pain scale scores at 3–6 weeks postoperatively and days of non-steroidal anti-inflammatory drug use favoring conventional laparoscopy. The operative times were significantly greater for RALSC (227±47 vs 161±47 min, mean difference 67 min, p<0.0001) [1]. RALSC cost more than conventional laparoscopic sacrocolpopexy (CLSC) with a mean difference of $2,196.00 (95%CI $660–3,732), driven primarily by the differences in technical costs associated with the procedures [2]. There is no realistic scenario where RALSC could cost less than CLSC. Robotic operative times would have to be reduced to 149 min from a published estimate time of 328 min and laparoscopic operative time would have to remain unchanged at 269 min to achieve cost equivalence. Robotic disposables would have to cost less than $2,132 from a published cost estimate of $3,293 and laparoscopic disposables would have to increase to more than $3,413 from $2,244 to achieve a lower cost for RALSC [3]. Currently there are no data to support the use of robot assistance over conventional laparoscopy for any surgical procedure. Maeso et al. identified 6 published randomized clinical trials (four fundoplications, one cholecystectomy, one Roux-en-Y gastric bypass) of 31 studies that met inclusion criteria for a systematic review and meta-analysis of the efficacy of the Da Vinci® Surgical System in abdominal surgery compared to conventional laparoscopy. None of the six published randomized clinical trials identified any outcomes that favored the Da Vinci® Surgical System except for the gastric bypass trial that found shorter operating room times for a new laparoscopy fellow presumably naive to either approach [4]. The Cochrane Collaboration reviewed five randomized clinical trials comparing robot-assisted laparoscopic cholecystectomy to conventional laparoscopy and found no significant advantage of robotic assistance for morbidity, conversion to open cholecystectomy, total operating time, or hospital stay [5]. Baik performed the first randomized clinical trial comparing robotic low anterior resection to a conventional laparoscopic approach and found no statistical difference in postoperative complications, number of harvested lymph nodes, resection margins, or mesorectal grading [6]. Morino randomized 20 consecutive patients requiring adrenalectomy to robot assisted versus conventional laparoscopy and found differences in operative time, conversion to open procedure, and perioperative morbidity that favored conventional laparoscopy. The total cost of the robot procedure was $3,467 compared to $2,737 for conventional laparoscopy (p<0.01) [7]. The Da Vinci® Surgical System has gained acceptance among the medical community because it shortens the learning curve for surgeons interested in performing minimally invasive procedures. Hospitals are purchasing these systems to meet the demand for minimally invasive procedures and maintain an advantage over their competition for surgical cases despite a lack of beneficial evidence and increased costs for robot assistance compared to conventional laparoscopy. The value of Intuitive Surgical, Inc. (Da Vinci® Surgical System) stock has grown 563% Further contributions to this debate can be found at doi:10.1007/ s00192-011-1618-6 and doi:10.1007/s00192-011-1619-5

One-stage Robotic-assisted Laparoscopic Cholecystectomy and Common Bile Duct Exploration With Primary Closure in 5 Patients

Surgical robotic systems are superior to traditional laparoscopic technologies with regard to generation of 3-dimensional images, and they also offer better instrumentation. Here, we report on our early results for 1-stage robot-assisted laparoscopic cholecystectomy and laparoscopic common bile duct exploration with primary closure. From March 2009 to July 2009, five consecutive patients underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration with primary closure assisted by the da Vinci robotic system. Patient demographics, intraoperative findings, postoperative complications, and length of postoperative hospital stay were recorded and analyzed. No patient required conversion to laparotomy or conventional laparoscopy. The average robotic console time was 176.0±32.1 minutes. One female patient developed postoperative pulmonary infection that was successfully treated medically; the others' postoperative courses were uneventful. The average length of postoperative stay was 5.8±2.5 days. At follow up, all 5 patients were free of recurrent stones. Robotic-assisted laparoscopic cholecystectomy and laparoscopic common bile duct exploration with primary closure are effective and safe for selected patients. Future experience is needed to further study the efficacy and role of this novel approach.

Two Procedures at the Same Robotic Session

A 66-year old male patient with right upper abdominal pain was diagnosed with cholelithiasis on abdominal ultrasound and elective laparoscopic cholecystectomy was recommended. His serum prostate-specific antigen was 21.3 ng/mL and underwent a 12-core transrectal ultrasound-guided prostate biopsy, which showed prostatic adenocarcinoma (Gleason score 4+4). Owing to the presence of concomitant cholelithiasis, we performed robot-assisted laparoscopic radical prostatectomy and robot-assisted laparoscopic cholecystectomy at the same session. Console time was 257 minutes. Intraoperative blood loss was 50 mL. Patient was fit to be discharged on postoperative day 2. Surgical specimen pathology showed a bilateral prostatic adenocarcinoma of Gleason score 4+3, with unilateral extracapsular extension and negative surgical margins. Currently, he is full continent with a serum prostate-specific antigen of 0.04 ng/mL on his first-month follow-up evaluation. Combined robotic approach seems to have many benefits including shorter hospital stay, decreased cost, decreased anesthesia risk, and better cosmetic results.

Robot-assisted laparoscopic cholecystectomy: Evaluation of learning curve, advantages and limitations

Robot-assisted laparoscopic cholecystectomy: Evaluation of learning curve, advantages and limitations

Clinical characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy: A report of 40 cases

To summarize the performing essentials and analyze the characteristics of remote Zeus robot-assisted laparoscopic cholecystectomy. Robot-assisted laparoscopic cholecystectomy was performed in 40 patients between May 2004 and July 2005. The operating procedures and a variety of clinical parameters were recorded and analyzed. Forty laparoscopic cholecystectomy procedures were successfully completed with Zeus robotic system. And there were no post-operative complications. Total operating time, system setup time and performing time were 100.3 +/- 18.5 min, 27.7 +/- 8.8 min and 65.6 +/- 18.3 min, respectively. The blood loss and post-operative hospital stay were 30.6 +/- 10.2 mL and 2.8 +/- 0.8 d, respectively. Camera clearing times and time used for operative field adjustment were 1.1+/- 1.0 min and 2.0 +/- 0.8 min, respectively. The operative error was 7.5%. Robot-assisted laparoscopic cholecystectomy following the principles of laparoscopic operation has specific performing essentials. It preserves the benefits of minimally invasive surgery and offers enhanced ability of controlling operation field, precise and stable operative manipulations.

Robot-Assisted Laparoscopic Cholecystectomy: Initial Mayo Clinic Scottsdale Experience

To review a single institution's experience with robot-assisted laparoscopic cholecystectomy. We reviewed retrospectively all cholecystectomies performed with the assistance of a surgical robot at the Mayo Clinic in Scottsdale, Ariz, from October 2002 to July 2003. Cholanglograms were obtained intraoperatively for patients with elevated results on liver function tests. The gallbladder was removed by the surgeon with the use of the robot. A surgical assistant at the operating table exchanged instruments in the robot arms and applied clips when needed. Total operating time, assembly time of the robot, complications, and postoperative course were evaluated. Nineteen patients underwent robot-assisted laparoscopic cholecystectomy; 16 had symptomatic cholelithiasis, 2 had gallbladder polyps, and 1 had acute cholecystitis. Of the 19 surgeries, 16 were completed successfully with robotic assistance. In 3 consecutive patients, a mechanical problem occurred with the robot; however, all procedures were completed laparoscopically. The mean set-up time, including patient positioning and preparation and robotic installation, was 28.1 minutes. The mean +/- SD operating time was 82.3+/-17.9 minutes without a cholanglogram and 102+/-20.9 minutes with a cholanglogram. There were no complications and no conversions to an open procedure. Robotic surgery offers many potential advantages, including surgeon comfort, elimination of surgeon tremor, improved imaging, and increased degrees of freedom of the operative Instruments, compared with conventional laparoscopic surgery. However, patient outcomes and operative costs need to be evaluated further.

Implementation of robotic laparoscopic cholecystectomy in a university hospital.

Robot surgery is a further step towards new potential developments in minimally invasive surgery. Surgeons must keep abreast of these new technologies and learn their limits and possibilities. Robot-assisted laparoscopic cholecystectomy has not yet been performed in our institution. The purpose of this report is to present the pathway of implementation of robotic laparoscopic cholecystectomy in a university hospital. The Zeus(R) robot system was used. Experimental training was performed on animals. The results of our experimental training allowed us to perform our first two clinical cases. Robot arm set-up and trocar placement required 53 and 35 minutes. Operative time were 59 and 45 minutes respectively. The overall operative time was 112 and 80 minutes, respectively. There were no intraoperative complications. Patients were discharged from the hospital after an overnight stay. Robotic laparoscopic cholecystectomy is safe and patient recovery similar to those of standard laparoscopy. At present, there are no advantages of robotic over conventional surgery. Nevertheless, robots have the potential to revolutionise the way surgery is performed. Robot surgery is not reserved for a happy few. This technology deserves more attention because it has the potential to change the way surgery is performed.

Implementation of robotic laparoscopic cholecystectomy in a university hospital.

Robot surgery is a further step towards new potential developments in minimally invasive surgery. Surgeons must keep abreast of these new technologies and learn their limits and possibilities. Robot-assisted laparoscopic cholecystectomy has not yet been performed in our institution. The purpose of this report is to present the pathway of implementation of robotic laparoscopic cholecystectomy in a university hospital. The Zeus(R) robot system was used. Experimental training was performed on animals. The results of our experimental training allowed us to perform our first two clinical cases. Robot arm set-up and trocar placement required 53 and 35 minutes. Operative time were 59 and 45 minutes respectively. The overall operative time was 112 and 80 minutes, respectively. There were no intraoperative complications. Patients were discharged from the hospital after an overnight stay. Robotic laparoscopic cholecystectomy is safe and patient recovery similar to those of standard laparoscopy. At present, there are no advantages of robotic over conventional surgery. Nevertheless, robots have the potential to revolutionise the way surgery is performed. Robot surgery is not reserved for a happy few. This technology deserves more attention because it has the potential to change the way surgery is performed.

Feasibility of robot-assisted laparoscopic cholecystectomy

To enhance the surgeon's dexterity in laparoscopic surgery, robotic telemanipulation systems have recently been introduced into the operating theatre. Feasibility of robot-assisted surgery was evaluated in this study during 20 laparoscopic cholecystectomies. The procedures were performed with the Da Vinci® robotic telemanipulation system (Intuitive Surgical). System set-up time, complications, technical problems and OR-time were recorded. The surgeon succeeded in completing the cholecystectomy laparoscopically in 19 out of 20 cases. Robot-related technical problems did occur in a low number of cases. This did not result in complications or harmful situations to the patient. OR time in robot-assisted cases exceeded the time needed for conventional laparoscopic cholecystectomy, mainly caused by time-loss during set-up.