Single-site Robotic Cholecystectomy Research Articles

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.

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.

Single-site robotic cholecystectomy and robotics training: should we start in the junior years?

BackgroundIt has become increasingly important to expose surgical residents to robotic surgery as its applications continue to expand. Single-site robotic cholecystectomy (SSRC) is an excellent introductory case to robotics. Resident involvement in SSRC is known to be feasible. Here, we sought to determine whether it is safe to introduce SSRC to junior residents. Materials and methodsA total of 98 SSRC cases were performed by general surgery residents between August 2015 and August 2016. Cases were divided into groups based on resident level: second- and third-years (juniors) versus fourth- and fifth-years (seniors). Patient age, gender, race, body mass index, and comorbidities were recorded. The number of prior laparoscopic cholecystectomies completed by participating residents was noted. Outcomes including operative time, console time, rate of conversion to open cholecystectomy, and complication rate were compared between groups. ResultsJuniors performed 54 SSRC cases, whereas seniors performed 44. There were no significant differences in patient age, gender, race, body mass index, or comorbidities between the two groups. Juniors had less experience with laparoscopic cholecystectomy. There was no significant difference in mean operative time (92.7 min versus 98.0 min, P = 0.254), console time (48.7 min versus 50.8 min, P = 0.639), or complication rate (3.7% versus 2.3%, P = 0.68) between juniors and seniors. ConclusionsSSRC is an excellent way to introduce general surgery residents to robotics. This study shows that with attending supervision, SSRC is feasible and safe for both junior and senior residents with very low complication rates and no adverse effect on operative time.

Robotic single-site versus multiport laparoscopic cholecystectomy: a case-matched analysis of short- and long-term costs.

Multiport laparoscopy is the gold-standard approach for cholecystectomy, and single-port laparoscopy has been developed to further reduce its invasiveness. A specific robotic single-port platform (da Vinci single-site, Intuitive Surgical Inc., Sunnyvale, CA, USA) has been released in 2011, which could technically facilitate single-site cholecystectomy. Current data show its feasibility; however, detailed short- and long-term analyses of costs and comparisons relative to multiport laparoscopy are not available to date. Patients who underwent robotic single-site cholecystectomy for benign, clinically noninflammatory disease between 2011 and 2015 were matched for disease, age, gender, BMI, ASA classification, diagnosis, and elapsed year of surgery to a cohort of multiport cholecystectomies. Demographic, perioperative, and long-term data were collected retrospectively and analyzed. Perioperative and long-term costs including re-operations due to the primary procedure until February 2017 were compared across both cohorts. 99 patients who underwent robotic single-site cholecystectomy were matched to 99 patients with multiport cholecystectomy. A higher rate of outpatient procedures in the robotic cohort (31.3 vs. 17.2%, p=0.0305) was found, and demographic parameters and perioperative clinical outcomes were similar. Perioperative costs were significantly higher for the robotic single-site patients (6158.0 vs. 4288.0 USD, p<0.0001). With similar follow-up times of 59.0 and 58.9months, respectively (p=0.9552), significantly more patients of the robotic Single-Site cohort underwent follow-up surgery (7.1 vs. 0.0%, p=0.0140), and follow-up costs were significantly higher for the robotic cohort (694.7 vs. 0.0 USD, p=0.0145). With similar early postoperative clinical results and a higher rate of re-operations, perioperative and long-term costs are significantly higher with robotic Single-Site cholecystectomy compared with multiport cholecystectomy. Considering the unclear clinical value of robotic single-site cholecystectomy and the significant short- and long-term costs, a call for further research and a debate as to who should bear the costs beyond the ones of the gold-standard treatment appear reasonable.

Single-incision robotic cholecystectomy is associated with a high rate of trocar-site infection.

Single-incision robotic cholecystectomy has been developed to decrease post-operative pain and improve cosmetic results. Thirty-seven patients underwent single-site robotic cholecystectomy between 2014 and 2015. Postoperative outcomes and costs were compared to reported outcomes for laparoscopic cholecystectomy using the configuration of suprapubic trocars. The median age was comparable between the two groups (46years in the robotic group vs. 47years in the laparoscopic group). The operative time was longer in the robotic group (132minutes) than in the laparoscopic group (53minutes). The average length of stay was 1day in the robotic group and 1.7days in the laparoscopic group. Costs were higher in the robotic group (2229.46 €) than in the laparoscopic group (1141 €). In the robotic group, the trocar-site infection rate was 13.5%. The robotic approach does not seem to offer additional benefit in terms of surgical outcomes.

Incisional hernia after robotic single-site cholecystectomy: a pilot study

Robotic LaparoEndoscopic Single-Site Surgery Cholecystectomy has been performed for 5years using a dedicated platform (da Vinci® Single-Site®) with the da Vinci® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA). While short-term feasibility has been described, long-term assessment of this method is currently outstanding. The aim of this study was to assess long-term parietal complications of this technique. In this retrospective study, patients operated between 2011 and 2013 were evaluated. Parietal incision was assessed with ultrasonography and patients screened for residual pain from scar tissue. Demographic and perioperative data were also collected. We evaluated 48 patients [38 female, 79.2%; median age 49years (range: 24-81years)]; mean BMI 25.9kg/m2 [±SD 4.1kg/m2]. After a median follow-up of 39months (range: 25-46months), six incisional hernias (two patients had a positive echography but a negative clinical examination) were found (12.5%, 95% CI 7.5-30.2), and two patients had a surgical repair. The overall rate of incisional hernia was 16.7% (95% CI 7.5-30.2). Residual pain was observed in 5 of 48 patients. This preliminary study suggests that a clinically significant rate of incisional hernias can occur after R-LESS-C. Larger studies comparing R-LESS-C to alternative methods with long-term follow-up are necessary.

Cosmesis, patient satisfaction, and quality of life after da Vinci Single-Site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial.

Single-incision laparoscopic cholecystectomy evolved from the traditional multiport laparoscopic technique. Prior trials have demonstrated improved cosmesis with the single-incision technique. Robotic single-site surgery minimizes the technical difficulties associated with laparoscopic single-incision approach. This is the first prospective, randomized, controlled study comparing robotic single-site cholecystectomy (RSSC) and multiport laparoscopic cholecystectomy (MPLC) in terms of cosmesis and patient satisfaction. Patients with symptomatic benign gallbladder disease were randomized to RSSC or MPLC. Data included perioperative variables such as operative time, conversion and complications and cosmesis satisfaction, body image perception, quality of life using validated questionnaires, at postoperative visits of 2, 6weeks and 3months. One hundred thirty-six patients were randomized to RSSC (N=83) and MPLC (N=53) at 8 institutions. Both cohorts were dominated by higher enrollment of females (RSSC=78%, MPLC=92%). The RSSC and MPLC cohorts were otherwise statistically matched. Operative time was longer for RSSC (61min vs. 44min, P<0.0001). There were no differences in complication rates. RSSC demonstrated a significant superiority in cosmesis satisfaction and body image perception (P value<0.05 at every follow-up). There was no statistically significant difference in patient-reported quality of life. Multivariate analysis of female patients demonstrated significantly higher preference for RSSC over MPLC in cosmesis satisfaction and body image perception with no difference seen in overall quality of life. Results from this trial show that RSSC is associated with improved cosmesis satisfaction and body image perception without a difference in observed complication rate. The uncompromised safety and the improved cosmesis satisfaction and body image perception provided by RSSC for female patients support consideration of the robotic single-site approach. ClinicalTrials.gov identifier NCT01932216.

Technical Compensation for Hepatic Vein Injury during Robotic Single Site Cholecystectomy

This video describes an event that could occur during any cholecystectomy. To the best of our knowledge, this video is the first description of the technical compensation for hepatic vein injury during robotic single-site cholecystectomy (RSSC). A 61-year-old male with a 1.6 cm gallbladder stone sought to go through with RSSC. During dissection of gallbladder from the liver bed, the hepatic vein was unexpectedly exposed and injured. Using the angulated robotic needle holder, the injured hepatic vein was repaired with 5-0 prolene monofilament suture. Although there is a lack of EndoWrist movement in RSSC, suturing was feasible. The patient was discharged on the second postoperative day without complications. Incidental hepatic vein injury could be safely managed using RSSC and prevent the need for conversion to a conventional laparoscopic or open approach.

Comparison study of clinical outcomes between single-site robotic cholecystectomy and single incision laparoscopic cholecystectomy

Multiport laparoscopic cholecystectomy is the standard surgical procedure for symptomatic gallbladder diseases. The latest evolution is single incision laparoscopic cholecystectomy (SILC). Single-site robotic cholecystectomy (SSRC) overcomes several limitations of manual SILC. The aim of this study is to present our initial experiences in SSRC and to compare its clinical outcomes with those of SILC. This study retrospectively reviewed data for patients who received SSRC or SILC from February 2014 to September 2015. The following variables were analyzed: age, sex, body mass index, indications, pain scale, length of stay, and complications. The data were analyzed with Student t test or by Fisher exact test. The analysis included 51 SSRC (33 women, 18 men) and 63 SILC patients (40 women, 23 men). Patients in both groups had similar demographic features and indications for surgery. The SSRC group required no conversions to conventional laparoscopy and no additional trocars, whereas the SILC group had two (3.17%) cases. Length of stay did not significantly differ between the SSRC and SILC groups (4.29±0.72 vs. 4.13±0.93days, respectively; p=0.823). However, the SSRC group had shorter operative time (71.30±48.88 vs. 74.70±30.16minutes; p=0.772), less perioperative bile spillage (9.81% vs. 19.05%; p=0.189), and less postoperative bile leakage (0% vs. 3.17%; p=0.501). However, the parameters mentioned above were not statistically significant, whereas pain scale scores were significantly lower in the SSRC group (2.11±0.76 vs. 3.98±0.84; p<0.01). Both SSRC and SILC are safe and feasible procedures for performing single incision cholecystectomy. SSRC, however, has the advantage of significantly decreased postoperative pain.

Robotic Single- and Multisite Cholecystectomy in Children.

Elective cholecystectomy is a high-volume, simple procedure, well suited for the development of a pediatric robotic surgery program. Surgical robot software, by "reversing" the surgeon's hands, simplifies single-site cholecystectomy through a single incision at the umbilicus. Data were reviewed on the first nine children who had robotic cholecystectomy, with the Da Vinci® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA) device, at our institution. All cases were performed by a single surgeon, proctored by an experienced robotic general surgeon. There were 9 patients: the first 4 patients had robotic multiport cholecystectomy, and the last 5 had robotic single-site cholecystectomy. Eight were girls. They were 10-18 years of age (median, 14 years). Diagnoses were biliary dyskinesia (n = 5) and symptomatic cholelithiasis (n = 4). Median body mass index was 24.9 (range, 20.2-43.8) kg/m(2). Median anesthesia time for multiport cholecystectomy was 139 (range, 120-162) minutes; median anesthesia time for single-site cholecystectomy was 169 (range 122-180) minutes. Median console time for multiport cholecystectomy was 47 (range, 44-58) minutes; median console time for single-site cholecystectomy was 69 (range, 66-86) minutes. Eight of the 9 patients went home on the day of surgery, and 1 stayed overnight. Patients were seen at 13-20 days after surgery (median, 14 days). There were no complications. There were no conversions to open surgery and none from single-site to multiport surgery. Robotic cholecystectomy is safe and efficacious and is a suitable introductory procedure for pediatric surgeons considering a robotic surgery program. Single-site robotic cholecystectomy is a cosmetically attractive option but takes longer than multiport robotic cholecystectomy.

A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases.

Recently, the robotic single-site platform has been used to ameliorate the difficulties seen in single-incision laparoscopic surgery (SILC) while preserving the benefits of standard laparoscopic cholecystectomy. The purpose of this study is to describe the clinical outcomes of a large series of single-incision robotic cholecystectomy (SIRC). Medical records of consecutive patients who underwent SIRC were retrospectively reviewed. All procedures were performed by six surgeons at five different North American centers involved in the study. All patients included in the study underwent a cholecystectomy attempted through single site at the umbilicus, using the da Vinci(®) Surgical System (Intuitive Surgical Inc. Sunnyvale, CA). A total of 465 patients met study criteria. Median age was 48years (range 18-89); 351 (75.5%) were female and 304 (66.4%) were overweight or obese. Except for gender, case characteristics differed significantly by surgeon/site. Previous abdominal surgery was reported for 226 (48.6%) cases. SIRC was successfully completed in 455 (97.8%) cases, and there were no conversions to open surgery. Median surgical time was 52min with a decreasing trend after 55-85 cases. Male gender, obesity and diagnoses other than biliary dyskinesia were independent predictors of longer surgical times. The complication rate was 2.6%. Our large, multicenter study demonstrates that robotic single-site cholecystectomy is safe and feasible in a wide range of patients.

Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial.

Randomized studies could not demonstrate significant outcome benefit after single-incision laparoscopic cholecystectomy compared to classic four-port laparoscopic cholecystectomy (CLC). The new robotic single-site platform might offer potential benefits on local inflammation and postoperative pain due to its technological advantages. This prospective randomized double-blind trial compared the short-term outcomes between single-incision robotic cholecystectomy (SIRC) and CLC. Two groups of 30 eligible patients were randomized for SIRC or CLC. During the first postoperative week, patients and study monitors were blinded to the type of procedure performed by four dressing tapes applied on the abdomen. Pain was assessed at 6h and on day 1, 7 and 30 after surgery, along with a 1-10 cosmetic score. No significant difference in postoperative pain occurred in the two groups at any time point nor for any of the abdominal sites. Nineteen (63%) SIRC patients reported early postoperative pain in extra-umbilical sites. Intraoperative complications which might influence postoperative pain, such as minor bleeding and bile spillage, were similar in both groups and no conversions occurred. The cosmetic score 1month postoperatively was higher for SIRC (p<0.001). Two SIRC patients had wound infection, one of which developed an incisional hernia. SIRC does not offer any significant reduction of postoperative pain compared to CLC. SIRC patients unaware of their type of operation still report pain in extra-umbilical sites like after CLC. The cosmetic advantage of SIRC should be balanced against an increased risk of incisional hernias and higher costs. ACTRN12614000119695 ( http://www.anzctr.org.au ).

Robotic single-site adrenalectomy.

Technological advances have brought about robotic single-site (RSS) cholecystectomy and hysterectomy. The application of RSS to additional procedures requires careful assessment of the surgeon learning curve, the technological limitations, patient selection criteria and associated outcomes. Patient demographics, BMI, surgical indications, adrenal size, OR times, length of stay, postoperative pain and complications were assessed. Thirty-three patients underwent RSS-A by a single surgeon with 53% being male, mean age 54±16years and mean BMI of 32.7. There were 18 left, 10 right, and 5 bilateral procedures for a total of 38 adrenal glands removed (mean tumor size 3.2cm). There were 5 conversions to a laparoscopic approach, and two to open approach. The necessity for conversion was not associated with age, BMI, tumor size, surgical side or pathology (p>0.05). The patients who underwent successful unilateral RSS-A had a profile of mean age 55, BMI 31, tumor size 3cm, and a mean operative time of 118±25.8min. Pain scores were <4 (10 point scale) in 67% of patients. 74% of patients were discharged on POD 1 and 96% were discharged by POD 2. An assessment of the quartile learning curve for the unilateral RSS-A showed operative times decreased from a mean of 124 to 103min after 21 cases (p=0.05). Patients with functioning and non-functioning tumors, along with those with obesity can safely be treated with RSS-A. The surgeon learning curve was associated with shortened operative times and not increased complication rates.

Single-Site Robotic Cholecystectomy: Reverse-Port Technique.

This study aims to introduce an alternative technique for effective single-site robotic cholecystectomy (SSRC) using a reverse port.Proper exposure of Calot's triangle is critical for safe laparoscopic cholecystectomy. Current robotic surgical systems are useful for single-site cholecystectomy. However, in exposing Calot's triangle, the gallbladder is usually retracted in a medial and upward direction, resulting in a narrow triangle. This intraoperative view is a major obstacle to safe laparoscopic cholecystectomy.From October 2013 to October 2014, 55 consecutive patients underwent SSRC by a single surgeon at Yonsei University Severance Hospital. Initially, 5 patients underwent the original robotic single site cholecystectomy technique, and the remaining 50 patients underwent robotic single site cholecystectomy using our reverse port technique.There were no differences between the SSRC-O (original port) group and the SSRC-R (reverse port) group in terms of patient age (P = 0.244), body mass index (P = 0.503), and pathologic conditions of the gallbladder (P = 0.841). Total operation time (132.6 vs 99.12 min; P = 0.009), actual dissection time (51.6 vs 30.28 min; P = 0.001), and console time (84.4 vs 50.46 min; P = 0.001) were all significantly shorter in the SSRC-R group. Mean intraoperative blood loss was minimal in both groups (20 vs 12.4 mL, P = 0.467), and bile spillage occurred in 2 patients of the SSRC-R group. There was one case of laparoscopic conversion in the SSRC-R group.The reverse port technique described in this study successfully widened Calot's triangle and improved the safety of the current robotic surgical system for single-site robotic cholecystectomy.

An Uncommon Diagnosis Mimicking Peritoneal Carcinomatosis

Peritoneal carcinomatosis is a term that characterizes the presence of extensive metastasis inside the peritoneal cavity, usually spread from a near-by primary malignancy. This diagnosis is associated with a grim prognosis, indicating intraperitoneal seeding or haematogenous dissemination from several types of tumors, including gastric, ovarian, pancreatic and colorectal cancers. There are, however, multiple non-neoplastic disease processes that can imitate peritoneal carcinomatosis on high-grade imaging. Our case presentation illustrates a rare and benign differential diagnosis in a patient who exhibited findings suspicious for peritoneal metastases with malignant ascites. A 79 year-old male with a PMH of DM, COPD, and BPH presented to the ER with the chief complaint of abdominal pain, distention, nausea, and malaise. He admits that the abdominal pain has been intermittent over the past 3 months and increasing severity. He admitted to a laparoscopic robotic singlesite cholecystectomy performed 7 months prior to this admission. A colonoscopy and endoscopy 1 year prior to this admission was normal. Abdominal CT demonstrated ascites and seven enhancing peritoneal lesions resembling implants. Abdominal MRI confirmed the findings. Paracentesis removed 2500ml of clear fluid, but cytology was non-diagnostic. A diagnostic laparoscopy found a 1.5cm abdominal wall nodule that was adherent to the anterior abdominal wall; no other peritoneal implants could be visualized. The liver appeared normal and there were no other gross abnormalities. Pathology of the lesion demonstrated granulomatous inflammation with fibrosis, with pigmented material resembling bile or a gallstone. Follow-up with the patient 2 weeks later demonstrated resolution of the ascites and abdominal pain. This case represents an extremely uncommon etiology of findings that were initially suspicious for peritoneal metastases. After thorough literature review, an explanation for this finding includes the spillage of bile during his laparoscopic cholecystectomy, which triggered an inflammatory response to the bile deposits trapped inside the peritoneum, mimicking the nodular implants of peritoneal carcinomatosis seen on computed tomography and magnetic resonance imaging. However, it is unclear why this occured in this patient specifically. Lingering questions include the possibility of genetic predisposition, the possibility of infection leading to an abnormal immune response resulting in granuloma formation, and the possibility of an existing disease such as Wegener's granulomatosis which lead to these findings. To conclude, a vast array of disease processes, including benign pathology, can mimic peritoneal carcinomatosis on imaging; thus, obtaining biopsies with appropriate histopathology and microbiology is vital in clenching the final diagnosis.

Single‐Site Robotic Cholecystectomy: The Timeline of Progress

To investigate the learning curve and perioperative outcomes of single-site robotic cholecystectomy during the first 102 cases by a single surgeon. A retrospective review of a prospectively maintained database was performed on the first 102 cases of single-site robotic cholecystectomy. Patients were divided into five chronological groups based on the date of surgery, with 20 patients in each group except the 5th group which had 22 patients. The groups were compared by docking time, robotic dissection time, and overall surgery time. A P value of 0.05 was used as statistically significant. The female to male ratio was 2:1. The mean age was 51 years (18-87) and the mean BMI was 28.26 (18-41). Overall, 69 % of the patients underwent elective cholecystectomy and 31 % required urgent surgery. In all, 17 % of patients had previous abdominal surgeries. In total, 45 % of procedures were regarded as same day surgery. The total mean length of stay was 1.97 days (0-8). The mean operative time was 110 min (36-265), mean robotic console time 70 min (26-179), and mean docking time 9 min (1-26). The overall conversion rate was 3.9 % and the complication rate was 4 %. The docking time, robotic time, and average operative time were significantly different in the first group as compared to the remaining the five groups (P = 0.001). Single-site robotic cholecystectomy is safe in both elective and urgent conditions, and in patients with previous abdominal surgeries. It has a short learning curve.

Description of robotic single site cholecystectomy and a review of outcomes.

New technologies have been developed to make laparoscopic cholecystectomy less invasive through single incision laparoscopic surgery (SILS), however this approach has its own limitations. Single incision robotic surgery (SIRC) is designed to overcome them. The concerns that limit adoption of this technology are attributed increases in costs, prolonged learning curves and surgical times. Here, we provide a literature review as well as our own experience with SIRC, with the intent to clarify these important concerns.

Robotic-assisted single-site cholecystectomy in children

BackgroundThough single incision laparoscopic cholecystectomy (SILC) is cosmetically appealing, it is technically a difficult operation. The recent introduction of robotic single-site cholecystectomy (RSSC) has made single incision cholecystectomy easier to perform. While a few papers have reported its application in adults, it has not been documented in children. MethodsData on seventeen consecutive children who underwent RSSC by a single surgeon over a ten-month period were retrospectively reviewed. Patient demographics, total operative time, console time, hospital stay, complications and reasons for procedural delay were recorded. ResultsSixteen operations were completed robotically using the single incision robotic platform. No major postoperative complications were noted. Median total operative time was 94 minutes with interquartile range (IQR) being 81.5–119.5 minutes. The median console time was 39 minutes (IQR: 30–72 minutes). The median total operative time for the first eight cases was 118 minutes (IQR: 103–127 minutes) and for the next nine cases 90 minutes (IQR: 76–93 minutes). Common causes for procedural delay were slipped clips, bile spillage, bleeding and leaking Single-Site® port. ConclusionsThis unique series of RSSC documents its feasibility and safety in children. A short learning curve and operative times comparable to RSSC in adults and SILC in children were observed. Being technically easier, RSSC becomes an attractive alternative to SILC to sustain its cosmetic benefit.

Single-Site Robotic Cholecystectomy at an Inner-City Academic Center.

Introduction:We investigate the safety and efficacy of single-site robotic cholecystectomy compared to laparoscopic cholecystectomy at an inner-city academic medical center.Materials and Methods:Retrospective analysis comparing single-site robotic to laparoscopic cholecystectomies from August 1, 2013, to January 31, 2015, was conducted. Age, gender, race, body mass index (BMI), total operative time (docking and console time for robotic cases), length of stay, comorbidities, and conversion to open procedures were examined. The χ2 and Student's t test were used for categorical and continuous data, respectively. A P ≤ 0.05 was considered statistically significant.Results:From August 2013 to January 2015, 70 single-site robotic cholecystectomies and 70 laparoscopic cholecystectomies were performed. Patients were older (mean age, 40.3 years vs 47.6 years; P = .0084), had a higher mean BMI (29.5 vs 32.4 kg/m2; P = .011), and had a higher assigned ASA (American Society of Anesthesiologists) classification (P = .024) in the laparoscopic than in the single-site group. Hypertension was more common in the laparoscopic group (P = .0078). Average docking time was 11.5 (SD 5.7) minutes, and the average console time was 52.8 (SD 22.5) minutes in the single-site group. Total operating time for the laparoscopic and single-site groups was not significantly different (111.5 minutes vs 106.0 minutes; P = .38). There were more conversions to open procedures in the laparoscopic compared to the single-site group (11 vs 1; P = .007). There were no biliary tree injuries and no deaths in either group.Conclusion:Single-site robotic cholecystectomy is safe to perform in an inner-city academic hospital setting. Surgical resident involvement does not adversely affect outcomes.

The first experiences of robotic single-site cholecystectomy in Asia: a potential way to expand minimally-invasive single-site surgery?

PurposeHerein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy.Materials and MethodsFrom October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC).ResultsFour female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group.ConclusionRSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.