Robotic Cholecystectomy Research Articles

Comparison of Intraoperative Outcomes between Single-incision Robotic Cholecystectomy and Multi-incision Robotic Cholecystectomy.

BackgroundThe aim of this study was to evaluate the differences in the key surgical factors for single-incision robotic cholecystectomy (SIRC) and multi-incision robotic cholecystectomy (MIRC).MethodsA retrospective data review from August 2013 to April 2018 consisting of 104 SIRC and 105 MIRC cases was done considering factors including patient gender, age, operating time (skin incision to skin closure), robotic console time (docking to undocking), the preoperative diagnosis for surgery, any complications in surgery, length of stay (LOS), and estimated blood loss (EBL). Procedures with conversion away from original robotic cholecystectomy approach were excluded. Chi-square analysis (p-value: 0.05) was run between the two data sets.ResultsA total of 209 robotic cholecystectomy cases were reviewed since 2013. We found significantly less time with single-incision compared to multi-incision (single incision = 94.0 minutes, multi-incision = 99.9 minutes, p = 0.016) and EBL (single-incision = 11.52 mL, multi-incision = 17.17 mL, p = 0.004). There was no significant difference in age or robotic console time. The most common indication was symptomatic cholelithiasis overall, with equal cases of dyskinesia in single-incision approach, although there was no significant difference in indication between the two approaches. Intraoperatively, there was marginally significant use of irrigation in multi-incision (multi-incision 45 [42.9%], single-incision 31 [29.8%], p = 0.0499) and no difference in Firefly, perforation, or intraoperative cholangiogram use. LOS results showed significant decreased stay in SIRC cases (single-incision 84 outpatients [80.8%], multi-incision 75 [71.4%]; p = 0.0379).ConclusionsSIRC and MIRC are both safe and feasible ways to remove the inflamed/dysfunctional gallbladder. SIRC is associated with less operative time, less blood loss, and shorter hospital stay.

Robotic Cholecystectomy: First Experience in Baltic Countries

[full article, abstract in English; abstract in Lithuanian]
 In this retrospective study we report the first series of robotic cholecystectomies in Baltic countries. From Nov 2018 to Feb 2019, 13 robotic cholecystectomies were performed in Klaipėda University Hospital using the Senhance (TransEnterix) robotic system. Patients were diagnosed with symptomatic gallstone disease and had no life-threatening co-morbidities. We retrospectively investigated patient demographics and pre-, peri- and postoperative data. Five male and eight female patients were included in this study (n = 13). Mean age was 46 years (range 26–72); mean BMI was 26.7 kg/m² (range 21.1–37.7). Mean docking time was 18 min (range 8–27), and mean operative time was 85 min (range, 70–150). There were no conversions to standard laparoscopy or open surgery. There were no intra-operative complications. There was one post-operative bleeding from the gallbladder bed and subhepatic hematoma, successfully treated by laparoscopy. This study demonstrates the feasibility of robotic surgery in performing minimally invasive cholecystectomies.

Looking beyond laparoscopic cholecystectomy – Will robotic cholecystectomy be the new the gold standard in patients with advanced liver disease?

Looking beyond laparoscopic cholecystectomy – Will robotic cholecystectomy be the new the gold standard in patients with advanced liver disease?

Bikini laparoscopic cholecystectomy: a replica of notes cholecystectomy

Background: Conventional four port laparoscopic cholecystectomy is the standard of care for symptomatic cholelithiasis. Single incision lap. chole, Needloscopic cholecystectomy, NOTES Lap. chole. and Robotic cholecystectomy has been described primarily to further minimize the trauma and to improve cosmetic outcome. However, the cosmetic benefit is offset by expenses, non ergonomic approach and a steep learning curve. A new economic and an aesthetic approach of laparoscopic removal of gall bladder through bikini incisions is described. The purpose of this study is to find out the feasibility and safety of this technique. Methods: Non obese Patients (BMI <25) with normal gall bladder wall thickness were included. Informed consent for conversion was obtained. Intra operative bladder decompression was done by urinary catheterization. Surgery was performed by standard operative steps in split leg position. Both legs were placed at 200 below the level of torso. The surgeon stood in middle of legs. Long bariatric instruments were used. The first assistant on left side and the scrub nurse was positioned on the right side of patient. A 10 mm camera port was inserted in mid line 2 cms above pubic symphysis and two 5 mm working ports in both mid clavicular lines in lower iliac fosse. Fourth 3 mm port to retract fundus was made in right hypochondrium if required. Results: Eighteen patients were operated with this technique as day care surgery from Nov. 2017–Sept. 2018. Patients of acute cholecystitis, abdomino pelvic surgery, Pancreatitis and endoscopic retrieval of CBD stones were excluded. Sixteen were female and two were male patients. Majority of them, 88.9% were young (24–40 years). Operative steps were similar to conventional laparoscopic cholecystectomy. Surgery was completed by three ports in ten patients. Eight patients (44.44%) required fourth 3 mm port in right hypochondrium to retract gall bladder fundus. Mean duration of surgery 50.6 minutes (35–75). Specimen was retrieved through supra pubic port under vision by putting a camera from one of the 5 mm port. No conversion or complications was observed. Patients were discharged on the same day. Mean Post op followed up was 6.8 months. All patients are doing well and none developed port site infection or hernia. Conclusion: Bikini laparoscopic cholecystectomy is feasible, safe, and can be successfully performed with conventional long laparoscopic instruments. Learning curve is minimal. Like NOTES hybrid cholecystectomy, this technique leaves an invisible scar hidden under garments and there is no escalation of the cost from conventional four ports Laparoscopic Cholecystectomy.

An Update on Technical Aspects of Cholecystectomy.

Laparoscopic cholecystectomy has revolutionized the field of surgery, and is currently the gold standard in the treatment for symptomatic cholelithiasis. The goal of every laparoscopic cholecystectomy should be attainment of the critical view of safety before cutting the cystic duct and artery to reduce the risk of bile duct injury. Open cholecystectomy is most commonly performed when laparoscopic cholecystectomy is converted to open or when laparoscopic cholecystectomy is contraindicated. Robotic cholecystectomy is a safe alternative to conventional laparoscopic cholecystectomy, and follows the same basic operative principles.

Clinical outcomes of robotic cholecystectomy: single center early experience

Introduction: Laparoscopic cholecystectomy is the gold-standard approach for gallbladder diseases. Recently, the robotic platform including single port has been released, which could technically facilitate cholecystectomy. Therefore, we report our early experience in robotic cholecystectomy at Chonbuk national medical. Method: From September 2017 to November 2018, all consecutive patients(n=72) who underwent robotic cholecystectomy were retrospectively analyzed. Variables of interest for this study were patient demographics, operative times for the procedure and morbidities. Result: Among 72 patients, the mean age was 43.4 years with range of 15-68 years. The male (n=26) to female (n=46) ratio was 1:1.8. The indication of cholecystectomy were stone in 57 cases and polyp in 15 cases. Single incision and 3-port robotic cholecystectomy were performed 59 and 13 cases, respectively. The mean docking and operating times were 8.6 and 83 mins. Total numbers of open or laparoscopic conversion are 2 cases due to sever adhesion. Postoperative complication was shown cholangitis in 1 case. (Clavien-Dindo classification grade 2) Conclusion: In our results, robotic cholecystectomy was shown feasible and safe procedures.

Single-port robotic cholecystectomy: Early experience from 12 cases

Introduction: Single-port laparoscopic cholecystectomy (SPLC) is a technical concept to reduced pain and improve cosmetic results when compared to multi-port cholecystectomy. However, SPLC is associated with technical limitation due to the enhanced complexity of the approach and limited number of specialized instruments or platforms. On the other hand, using a robotic platform may overcome these problems and enable more precise surgical actions by increasing freedom of movement and by restoring intuitive instrument control. In this presentation, we report the early clinical experience of our first 12 sing-port robotic cholecystectomy (SPRC). Method: Between November 2016 and July 2017, twelve patients underwent SPRC with the da Vinci Xi robot and single-site instrumentation. We retrospectively reviewed clinical data on those patients. Result: All of 12 patients had completion of SPRC. ten patients were female and two was male. Average patient age was 43.3±11.8 years and BMI was 22.4±1.4 kg/m2. Seven patients (58.3%) were diagnosed with chronic calculous cholecystitis. Four patients (33.3%) underwent operation for polypoid lesions of the gallbladder. One patient (8.3%) was diagnosed with acute calculous cholecystitis. The mean operation time (skin-to-skin) was 83.9±30.7 min, docking time was 13.25±8.1 min, and console time was 42.1±26.4 min. The intraoperative blood loss was negligible. The mean Visual Analog Pain Scale score 6hr after the surgery was 2.9±0.4. The mean length of hospital stay average postoperative hospital stay was 2.3±1.0 day. There were no intraoperative complication and one patient developed seroma on port site. Conclusion: Robotic single-port cholecystectomy appears feasible and safe in our early experience.

Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy -Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy -Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Robotic cholecystectomy: first experience with the new Senhance robotic system.

This retrospective study was performed to evaluate the safety and feasibility of the new Senhance robotic system (Transenterix) for robotic cholecystectomy. Our series is the first experience with cholecystectomies utilizing this new platform. From May 2017 to August 2017, 20 robotic cholecystectomies were performed using the Senhance robotic system. Patients were between 23years and 78years of age, eligible for a laparoscopic procedure with general anesthesia, with no life-threatening co-morbidities that limited the subjects' life-expectancy to fewer than 12months. A retrospective chart review was performed for a variety of pre-, peri- and postoperative data including, but not limited to patient demographics, intraoperative complications and postoperative complications. 9 male and 11 female patients were included in this study. Median age was 39.5years (range 23-78); median BMI was 27.35kg/m2 (range 22.8-48.3). Median docking time was 10min (range 2-26), and median operative time was 71.5min (range 34-197). Conversion to standard laparoscopy occurred in one case for lysis of extensive adhesions. There were no conversions to open technique. There were no intra- or post-operative complications noted. We report the first series of robotic cholecystectomies using the new Senhance system. Docking time and total operative time decreased significantly over the course of this series and did not plateau; console time did not change significantly. This study demonstrates the feasibility of utilizing this platform in performing minimally invasive cholecystectomies.

New Ports Placement for Robotic Cholecystectomy

Introduction: Since advantages of robotic surgery is being more emphasized, robotic cholecystectomy (RC) cases are increasing. Ajou group had introduced a method called which technique places the trocars transversally on the bikini line and it makes cosmesis and pain beneficial. However, RC with low incision port has several limitations. Therefore, we changed port placement which may be a one of safe tehniques for RC. Method: This study retrospectively reviewed data for patients who received RC with port changing method (RCPC, n = 33) and RC with low incision port (RCLI, n = 81) from February 2016 to February 2017 and surgical variables were analyzed. Results: Patients in both groups had similar demographic features and indications for surgery. The RCPC group required no conversions to conventional robotic surgery and no additional operation, whereas the RCLI group had one incisional hernia (1.2%) and two bowel perforation (2.4%) cases. Length of stay (4.29 ± 0.72 vs. 5.13 ± 0.93 days, respectively; p = 0.123) did not significantly differ between the RCPC and SCLI groups. However, the RCPC group had shorter operative time (71.30 ± 48.88 vs. 74.70 ± 30.16 minutes; p = 0.772) than the RCLI group, although the parameters mentioned above were not statistically significant. Conclusion: Robotic cholecystectomy with bikini line incision has some limitations even though it has cosmetic benefits. Whereas robotic surgery with changing port method is one of safe and feasible procedures for performing robotic cholecystectomy. Also nothing more to say that it gains cosmesis effect and escapes complications.

An analysis of the iatrogenic biliary injury after robotic cholecystectomy. Current data and future considerations.

Minimally invasive techniques are the gold standard in surgery. Since conventional laparoscopic approach has been widely adopted, surgeons in their effort to further improve their skills passed to the era of the robotic assistance. The widespread adoption of robotics has led to the inevitable usage of robotic technology both in simple, as well as in more complicated procedures. Cholecystectomy is the "simple" surgical procedure to which every surgeon from the beginning of his career and besides specialization or subspecialization is exposed to, but the ran complications have a dramatic impact both for patient and doctor. The elimination of bile duct injury is crucial and robotics in the new era of surgery has to be the gold standard to a safe cholecystectomy. A comprehensive search of PubMed Database was conducted for English-language studies using the MeSH terms [Robotic cholecystectomy, bile duct injury]. We reviewed references of all reports for additional cases from 2000 to nowadays. We used the related articles link and searched the citations of reports in the ISI Science Citation Index to identify additional reports. A total of 16 studies, including 2.264 patients that underwent robotic cholecystectomy were analyzed. Postoperative data and complications were collected from these studies. Bile duct injuries were more likely to be discovered during the first postoperative days as a bile leakage (8/2.264). One major bile duct injury was noticed, and most injuries were definitively treated at the hospital where the injury occurred with postoperative endoscopic retrograde cholangiopancreatography (ERCP) and stenting. Robotic cholecystectomy is a safe and adequate alternative to conventional laparoscopic or open approach in term of safety. Furthermore, surgeons must be already experienced and familiar with robotic techniques, so as to overcome the problem of the bile duct injury.

Is the 8-mm robotic port safe? a case of trocar site hernia after robotic cholecystectomy using the da Vinci Xi system

Is the 8-mm robotic port safe? a case of trocar site hernia after robotic cholecystectomy using the da Vinci Xi system

Robotic-assisted completion Cholecystectomy: a safe and effective minimally invasive approach to a challenging surgical scenario

Background: Subtotal cholecystectomy remains a viable and safe option when intraoperative conditions preclude visualization of the Critical View of Safety. 1.8% of these patients eventually require a reoperation. Traditionally, completion cholecystectomy following subtotal cholecystectomy required an open approach. In this study, we present our institutional experience with 16 robotic-assisted completion cholecystectomies following previous subtotal cholecystectomy. Methods: Operating room logs were reviewed from 2010-2017 to identify all robotic cholecystectomies performed at our institution. Review of all operative reports identified 16 completion cholecystectomies following a previous subtotal cholecystectomy. All additional variables including demographics, operative variables, and postoperative outcomes were collected from EMR records. Results: Median time from previous subtotal cholecystectomy to robotic completion cholecystectomy was 84 months (7 years). 58.3% of patients previously underwent an open subtotal cholecystectomy. The remaining patients underwent a laparoscopic subtotal cholecystectomy. Additional demographics and outcomes can be seen in Table 1. One patient required oral antibiotics for incisional site erythema. No patients required a conversion to an open procedure and average length of stay was 1.1 days. Conclusions: Although traditionally performed with an open approach, we have had success in recent years at our institution with a robotic-assisted approach to completion cholecystectomy. The robotic platform offers certain advantages in a hostile, reoperative field which allows these procedures to be performed in a minimally invasive fashion with a low rate of conversion. Previously limited to case reports, this series of 16 procedures represents the largest case series of robot-assisted completion cholecystectomies to date.TP20-02 Table 1Demographics and outcomes for 16 robotic-assisted completion cholecystectomy following subtotal cholecystectomyDemographicsAverage Age49.5 yearsAverage BMI32.8 kg/m2Average ASA2.6OutcomesAverage OR Time118.1 minutesAverage EBL46.9ccAverage LOS1.1 days Open table in a new tab

Safety of single-incision robotic cholecystectomy for benign gallbladder disease: a systematic review.

Multiport laparoscopic cholecystectomy (MLC) is the gold standard technique for cholecystectomy. In order to reduce postoperative pain and improve cosmetic results, the application of the single-incision laparoscopic cholecystectomy (SILC) technique was introduced, leading surgeons to face important challenges. Robotic technology has been proposed to overcome some of these limitations. The purpose of this review is to assess the safety of single-incision robotic cholecystectomy (SIRC) for benign disease. An Embase and Pubmed literature search was performed in February 2017. Randomized controlled trial and prospective observational studies were selected and assessed using PRISMA recommendations. Primary outcome was overall postoperative complication rate. Secondary outcomes were postoperative bile leak rate, total conversion rate, operative time, wound complication rate, postoperative hospital stay, and port site hernia rate. The outcomes were analyzed in Forest plots based on fixed and random effects model. Heterogeneity was assessed using the I2 statistic. A total of 13 studies provided data about 1010 patients who underwent to SIRC for benign disease of gallbladder. Overall postoperative complications rate was 11.6% but only 4/1010 (0.4%) patients required further surgery. A postoperative bile leak was reported in 3/950 patients (0.3%). Conversion occurred in 4.2% of patients. Mean operative time was 86.7min including an average of 42min should be added as for robotic console time. Wound complications occurred in 3.7% of patients. Median postoperative hospital stay was 1day. Port site hernia at the latest follow-up available was reported in 5.2% of patients. The use of the Da Vinci robot in single-port cholecystectomy seems to have similar results in terms of incidence and grade of complications compared to standard laparoscopy. In addition, it seems affected by the same limitations of single-port surgery, consisting of an increased operative time and incidence of port site hernia.

Single-site robotic cholecystectomy: comparison of clinical outcome and the learning curves in relation to surgeon experience in a community teaching hospital

BackgroundThe aim of this study was to analyze the experience of two surgeons who have different laparoscopic skills and case volume, with single-site robotic cholecystectomy (SSRC) and evaluate their learning curves.MethodsAll SSRCs performed between March 2013 and April 2015 were retrospectively reviewed. The patients were divided among two surgeons based on the surgeon’s level of laparoscopic skills and case volume. Surgeon 1 had experience in advanced laparoscopy while surgeon 2 had basic laparoscopic skills. Patients’ demographic data, intraoperative and short-term postoperative results were assessed.ResultsThe analysis included 102 patients for surgeon 1 and 15 patients for surgeon 2. There were no major or minor complications in either cohort. Operative time was significantly longer for surgeon 2, conversion to laparoscopy rate was 4% for surgeon 1 compared to 20% for surgeon 2, P = 0.044, which is statistically significant.ConclusionsSSRC is an easy and safe procedure that can be quickly learned and performed in a reproducible manner by surgeons with experienced laparoscopic skills and greater case volume.

Single-site robotic cholecystectomy versus multi-port laparoscopic cholecystectomy: A systematic review and meta-analysis

ObjectiveTo investigate the outcomes of single-site robotic cholecystectomy (SSRC) compared to multi-port laparoscopic cholecystectomy (MLC), evaluate the safety and feasibility of SSRC. MethodsTo find relevant studies, the electronic databases PubMed, MEDLINE, The Cochrane Library, and EMBASE were used to seek information in English literature from 2011 to 2017. Studies comparing SSRC to MLC, for any indication, were included in the analysis. This systematic review and meta-analysis was performed with RevMan Version 5.3. ResultsSeven studies (two randomized control trails (RCTs) and five comparative studies, n = 1657 patients) were included in our analysis. The data showed that the SSRC and MLC had equivalent outcomes for operative time (MD = −3.06, 95% CI: −7.61-1.49, p = 0.19), bleeding (OR = 1.63, 95%CI: 0.40–6.56, p = 0.49), postoperative complications (OR = 1.11, 95%CI: 0.35–3.51, p = 0.86), bile leakage (OR = 0.38, 95%CI: 0.07–2.00, p = 0.26), wound infection (OR = 1.92, 95%CI: 0.86–4.32, p = 0.11), conversion rate (OR = 1.30, 95% CI: 0.71–2.37, p = 0.40), and hospital stay (MD = −0.02, 95% CI: −0.60-0.57, p = 0.96). However, in the SSRC group the risk of incisional hernia is higher than the MLC group (OR = 4.23, 95% CI: 1.87–9.58, p = 0.0005), incidence of incisional hernia rate in SSRC group is higher than MLC group (5.8% vs. 0.9%), and the total costs in the SSRC group is higher than MLC group (MD = 3.51, 95% CI: 0.31–6.71, p = 0.03). ConclusionsThe medical cost is significantly higher in SSRC compared with MLC, and SSRC can increasing the risk of incisional hernia. Therefore, surgeons must be carefully balanced its advantage, disadvantage and risk.

Robotic-assisted completion cholecystectomy following previous subtotal cholecystectomy - a case series

Background: Subtotal cholecystectomy remains a viable and safe option when intraoperative conditions preclude visualization of the Critical View of Safety. 1.8% of these patients eventually require a reoperation. Traditionally, completion cholecystectomy following subtotal cholecystectomy required an open approach. In this study, we present our single institution experience with 16 robotic-assisted completion cholecystectomies following previous subtotal cholecystectomy. Methods: Operating room logs were reviewed from 2010–2017 to identify all robotic cholecystectomies performed at our institution. Review of all operative reports identified 16 completion cholecystectomies following a previous subtotal cholecystectomy. All additional variables including demographics, operative variables, and postoperative outcomes were collected from EMR records. Results: Median time from previous subtotal cholecystectomy to robotic completion cholecystectomy was 84 months (7 years). 58.3% of patients previously underwent an open subtotal cholecystectomy. The remaining patients underwent a laparoscopic subtotal cholecystectomy. Additional demographics and outcomes can be seen in Table 1. One patient required oral antibiotics for incisional site erythema. No patients required a conversion to an open procedure and average length of stay was 1.1 days. Conclusion: Although traditionally performed with an open approach, we have had success in recent years at our institution with a robotic-assisted approach to completion cholecystectomy. The robotic platform offers certain advantages in a hostile, reoperative field which allows these procedures to be performed in a minimally invasive fashion with a low rate of conversion. Previously limited to case reports, this series of 16 procedures represents the largest case series of robot-assisted completion cholecystectomies to date.

The emerging role for robotics in cholecystectomy: the dawn of a new era?

Though laparoscopic cholecystectomy (LC) was highly criticized in its early stages, it quickly grew to become a new standard of care and has revolutionized the field of general surgery. Now emerging robotic technology is making its way into the minimally invasive arena. Robotic cholecystectomy (RC) is often disparaged as a costly technology that can lead to increased operative times with outcomes that are quite similar to LC. However, this perspective is skewed as many existing studies were performed in the early phase of learning for this procedure. RC can be performed in a cost-effective manner as the volume of robotic procedures increases. In addition, improved visualization and capability to perform fluorescence cholangiography can improve the safety profile of cholecystectomy to a level that has not yet been achieved with conventional laparoscopy. Advanced simulation technology for robotic surgery, and newer single-site robotic platforms have the potential to further revolutionize this technology and lead to improved patient satisfaction. In this review, we will present current data, trends, and controversies in robotic-assisted cholecystectomy.

Building a Single-Site Robotic Cholecystectomy Program in a Public Teaching Hospital: Is It Safe for Patients and Feasible for Residents to Participate?

Single-site robotic cholecystectomy (SSRC) accounts for most of the robotic surgery cases performed by general surgeons at our institution since acquiring the da Vinci Si Surgical SystemTM (Intuitive Surgical, Inc., Sunnyvale, CA) in 2014. We sought to determine whether a SSRC program is safe to start in a public teaching hospital and to determine whether resident participation in this procedure is feasible. Data on age, gender, race, BMI, total operative time, length of stay, comorbidities, and conversion from laparoscopic to open surgery were examined for elective SSRC and laparoscopic cholecystectomies (LCs) performed by two faculty surgeons between February 2015 and August 2015. Thirty-eight patients underwent elective SSRC, whereas 27 patients underwent LC. Residents participated as operating surgeons for some portion of the case in 15 SSRC cases and in all LC cases. There were no significant differences in operative time, length of stay, or 30-day readmission rates, regardless of resident involvement. Patients in the SSRC group had a significantly lower BMI (25.8 vs 33.7, P = 0.008). This study suggests that resident participation does not increase complications or total operative time and that SSRC is a safe procedure to start in a public teaching hospital after proper faculty and resident training.