Single-incision Robotic Cholecystectomy Research Articles

O53: Robotic Benign Upper GI Surgery: A Systematic Review

Abstract Robotic surgery has gained popularity in General Surgical units for resectional procedures, however its use in 'benign' operations is limited in the UK. We aim to review the current literature for common benign UGI operations. Methods Using PRISMA guidelines, we completed a literature search of MEDLINE and EMBASE including all evidence for Robotic Cholecystectomy (RC), Robotic Heller Cardiomyotomy (RH), Robotic Fundoplication (RF), Robotic Hiatus Hernia Repair (RHHR). Data was extracted and synthesised by independent reviewers.103 studies were included. 55 for RC, 12 for RH, 20 for RF and 14 for RHHR. The majority of these studies were cohort and case-control studies (53%). There were only 9 RCTs. Results Due to significant heterogeneity in patient population, study design and outcome reporting, meta analyses were not appropriate. Trends observed for RC suggested that the robotic method can lead to improved post-operative pain and cosmesis, especially in single-incision robotic cholecystectomy (SIRC). However 2 cohort studies stated a small increased risk of CBD injury. Evidence for RH show shorter operative time and reduced risk of oesophageal perforation, with other outcomes equivalent. Studies for RF showed equivalence between laparoscopic and robotic methods. In more complex hiatus hernia repair or re-operative operations (RHHR), studies showed shorter operative time, reduced complication rate and equivalent recurrence. Conclusion This systematic review has highlighted the paucity of high quality evidence for robotic Upper GI procedures. Studies show at least equivalence between robotic and laparoscopy for less complex procedures, with strong trends towards superiority for more complex procedures such as RH and RHHR.

Single-incision robotic cholecystectomy comparing the new da Vinci SP with the previous Si/Xi systems

Single-incision robotic cholecystectomy comparing the new da Vinci SP with the previous Si/Xi systems

OGBN P11 Robotic Benign Upper GI Surgery: A Systematic Review

Abstract Background Robotic surgery has gained popularity in General Surgical units for resectional procedures, however its use in ‘benign' operations is limited in the UK. We aim to review the current literature for common benign UGI operations. Methods Using PRISMA guidelines, we completed a literature search of MEDLINE and EMBASE including all evidence for Robotic Cholecystectomy (RC), Robotic Heller Cardiomyotomy (RH), Robotic Fundoplication (RF), Robotic Hiatus Hernia Repair (RHHR). Data was extracted and synthesised by independent reviewers. 103 studies were included. 55 for RC, 12 for RH, 20 for RF and 14 for RHHR. The majority of these studies were cohort and case-control studies (53%). There were only 9 RCTs. Results Due to significant heterogeneity in patient population, study design and outcome reporting, meta analyses were not appropriate. Trends observed for RC suggested that the robotic method can lead to improved post-operative pain and cosmesis, especially in single-incision robotic cholecystectomy (SIRC). However 2 cohort studies stated a small increased risk of CBD injury. Evidence for RH show shorter operative time and reduced risk of oesophageal perforation, with other outcomes equivalent. Studies for RF showed equivalence between laparoscopic and robotic methods. In more complex hiatus hernia repair or re-operative operations (RHHR), studies showed shorter operative time, reduced complication rate and equivalent recurrence. Conclusions This systematic review has highlighted the paucity of high quality evidence for robotic Upper GI procedures. Studies show at least equivalence between robotic and laparoscopy for less complex procedures, with some strong trends towards superiority for more complex procedures such as RH and RHHR.

Pediatric Single-Incision Robotic Cholecystectomy: A 6-Year Update from a Single Institution.

Introduction: In children, gallbladder disease has become more common due to the rise in childhood obesity and subsequent shift in etiology. While the gold standard of surgical management remains a laparoscopic technique, there has been increasing interest in robotic-assisted techniques. The aim of this study is to report a 6-year update on the experience of treating gallbladder disease with robotic-assisted surgery at a single institution. Materials and Methods: A database was created to prospectively collect patient demographic and operative variables at the time of operation from October 2015 to May 2021. Descriptive analysis of select available variables was performed using median and interquartile ranges (IQRs) for all continuous variables. Results: In total, 102 single-incision robotic cholecystectomies and one single-port subtotal cholecystectomy were performed. From available data, 82 (79.6%) patients were female, median weight was 66.25 kg (IQR: 58.09-74.24 kg), and median age was 15 years (IQR: 15-18 years). Median procedure time was 84 minutes (IQR: 70.25-103.5 minutes) and median console time was 41 minutes (IQR: 30-59.5 minutes). The most frequent preoperative diagnosis was symptomatic cholelithiasis (79.6%). One (0.97%) operation was converted from a single-incision robotic approach to open. Conclusion: Single-incision robotic cholecystectomy is a safe and reliable technique for the treatment of gallbladder disease in the adolescent population.

A single-center experience of over 300 cases of single-incision robotic cholecystectomy comparing the da Vinci SP with the Si/Xi systems

Minimally invasive surgery is usually more beneficial than open surgeries in various fields of surgery. With the newly developed Single-Port (SP) robotic surgical system, even single-site surgery has become easier to access. We compared single-incision robotic cholecystectomy between the Si/Xi and SP systems. This retrospective single-center study enrolled patients who underwent single-incision robotic cholecystectomy between July 2014 and July 2021. The clinical outcomes of the da Vinci Si/Xi and SP systems were compared. In total, 334 patients underwent single-incision robotic cholecystectomy (118 Si/Xi vs. 216 SP). The SP group had more chronic or acute cholecystitis than the Si/Xi group did. There was more bile spillage in the Si/Xi group during the surgery. The total operative and docking times were significantly shorter in the SP group. There was no difference in the postoperative outcomes. The SP system is safe and feasible regarding comparable postoperative complication rates and is more convenient regarding docking and techniques.

Comparative outcomes of single-incision laparoscopic, mini-laparoscopic, four-port laparoscopic, three-port laparoscopic, and single-incision robotic cholecystectomy: a systematic review and network meta-analysis.

Benign gallbladder diseases are common in surgery department, and the laparoscopic cholecystectomy (LC) is the gold standard procedure for benign diseases of gallbladder. Laparoscopic cholecystectomy is conventionally performed using four laparoscopic ports. However, the clinical application of different LCs is equivocal and there is no comprehensive comparison to explore which surgical options could benefit patients with benign gallbladder diseases. A network meta-analysis (NMA) to evaluate the efficacy of the different LCs could benefit patients with benign gallbladder diseases by comprehensive comparison. A systematic literature search was performed using PubMed, Embase, and Cochran Library. Totally, 17 randomized controlled trials (RCTs) (n = 1627) met study selection criteria and were incorporated in this NMA study. The first ranking probabilities of the five surgical options to alleviate postoperative pain scores were: 54.4% for single-incision robotic cholecystectomy (SIRC), 25.2% for single-incision laparoscopic cholecystectomy (SALC), and 24.9% for mini-laparoscopic cholecystectomy (Mini). The first ranking probabilities for reducing postoperative complications in the surgical options were: 61.3% for three-port laparoscopic cholecystectomy and 21.8% for four-port laparoscopic cholecystectomy. The first ranking probabilities for reducing hospital stay(days) in the surgical options were: 32.3% for SIRC, 29.0% for three-port laparoscopic cholecystectomy and 19.8% for four-port laparoscopic cholecystectomy. The first ranking probabilities for reducing operation time showed that the three-port technique had the shortest operation time, followed by three-port laparoscopic cholecystectomy (51.3%), four-port laparoscopic cholecystectomy (26.8%), and mini-laparoscopic cholecystectomy (21.6%). Our study found that the optimal surgical plan for different outcomes varies, making it difficult to give a comprehensive recommendation. Three-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy may be the best options in terms of reducing surgical complications and operative time. Meanwhile, SIRC is the best options for relieving postoperative pain relief. SIRC and three-port laparoscopic cholecystectomy can reduce hospital stay (days) compared other LCs.

A retrospective multicenter study on evaluation of perioperative outcomes of single port robotic cholecystectomy comparing the Xi and SP version of da Vinci Robotic Surgical System

Single-incision-robotic cholecystectomy (SIRC) using the da Vinci Xi system (Xi) (Intuitive, Sunnyvale, CA, USA) is a safe and effective operation. Recently, the da Vinci SP system (SP) (Intuitive) which is a new platform specialized for single-port surgery has been released. The study aimed to compare perioperative outcomes of Xi and SP in regards to SIRC. In this multicenter retrospective cohort study, patients who underwent SIRC with benign gallbladder disease between 2019 and 2020 were enrolled. In Seoul National University Hospital, Xi was used with 3 separate arms of instruments inserted through the single incision made in umbilical area. In Ewha Womans University Seoul Hospital, SP was used with single multi-channel port through the umbilical incision. Patient's demographics, intraoperative factors, postoperative complications, and postoperative pain were investigated. 258 patients underwent SIRC with Xi, and 72 patients with SP. There were significant differences between Xi and SP groups in operation time at console (23.1 vs. 20.3 min, p = 0.018), numbers of postoperative analgesic injection (4.0 vs. 3.2, p < 0.001), NRS at day of operation (5.7 vs. 4.9, p < 0.001), but no difference in total operation time (43.4 vs. 45.9, p = 0.155) and postoperative complication (0.8% vs. 0.0%, p > 0.999). SP group showed more estimated blood loss (14.3 vs. 19.2 mL, p = 0.031). Although operation time at console was shorter and pain was less in SP group statistically, clinical benefit appears to be minimal. Both Xi and SP can be a safe and feasible platform to perform SIRC, but further investigation is needed as prospective study.

Laparoscopic surgery and robotic surgery for single-incision cholecystectomy: an updated systematic review.

The role of single-incision laparoscopic cholecystectomy (SILC) and single-incision robotic cholecystectomy (SIRC) is still unclear. We update the summarization of the feasibility and safety of SILC and SIRC. A comprehensive search of SILC and SIRC of English literature published on PubMed database between January 2015 and November 2020 was performed. A total of 70 articles were included: 41 covering SILC alone, 21 showing SIRC alone, 7 reporting both, and 1 study not specified. In total, 7828 cases were recorded (SILC/SIRC/not specified, 6234/1544/50); and the gender of 7423 cases was definitively reported: the female rate was 64.0% (SILC/SIRC/not specified, 62.1%/71.5%/74.0%). The weighted mean for body mass index (BMI), operative time, blood loss and post-operative hospital stay was 25.5kg/m2 (SILC/SIRC, 25.0/27.0kg/m2), 73.8min (SILC/SIRC, 68.2/88.8min), 12.6mL (SILC/SIRC, 12.1/14.8mL) and 2.5days (SILC/SIRC, 2.8/1.9days), respectively. The pooled prevalence of an additional port, conversion to open surgery, post-operative complications, intraoperative biliary injury, and incisional hernia was 4.1% (SILC/SIRC, 4.7%/1.9%), 0.9% (SILC/SIRC, 0.7%/1.5%), 5.9% (SILC/SIRC, 6.2%/4.1%), 0.1% (SILC/SIRC, 0.2%/0.09%), and 2.1% (SILC/SIRC, 1.4%/4.8%), respectively. Compared with conventional laparoscopic cholecystectomy, SIRC has experienced more postoperative incisional hernias (risk difference = 0.05, 95% confidence interval 0.02-0.07; P < 0.0001). By far, SILC and SIRC have not been considered a standard procedure. With the innovation of medical devices and gradual accumulation of surgical experience, feasibility and safety of performing SILC and SIRC will improve.

Comparison of outcomes of single incision robotic cholecystectomy and single incision laparoscopic cholecystectomy.

Backgrounds/AimsMultiport laparoscopic cholecystectomy is the standard surgical procedure for symptomatic gallbladder diseases. However, as a result of the ongoing trend toward minimally invasive laparoscopy, single-incision laparoscopic cholecystectomy (SILC) has evolved. Single-incision robotic cholecystectomy (SIRC) can overcome several limitations of manual SILC. The purpose of this study is to evaluate and compare the safety and feasibility of SIRC and SILC.MethodsThis study retrospectively reviewed data for all patients who underwent SIRC or SILC from March 2018 to July 2019 in a single institution. The following variables were analyzed: age, sex, body mass index, pain scale, length of stay, and complications. The data were analyzed using the Independent two sample t-test or the Fisher’s exact test.ResultsA total of 343 patients underwent SIRC or SILC during the study period. After excluding patients with acute cholecystitis, 197 SIRC and 103 SILC patients were analyzed in this study. The surgery time and postoperative hospital stay did not differ between SIRC and SILC. However, the SIRC patients experienced less bile spillage during the surgery than did the SILC patients (SIRC vs. SILC: 24 (23.3%) vs. 11 (5.6%) cases, respectively; p<0.001). Although there was no difference in the incidence of postoperative complications between procedures, additional pain control was administered more frequently in SILC patients (SILC 1.08±0.893, SIRC 0.58±0.795; p<0.001).ConclusionsWhile both SILC and SIRC are effective for single-incision cholecystectomy, SIRC was superior to SILC in terms of technical stability. Moreover, it has the advantage of postoperative pain control.

Robotic surgery enables safe and comfortable single-incision cholecystectomy: A comparison of robotic and laparoscopic approaches for single-incision surgery.

Background:Although single-incision robotic cholecystectomy (SIRC) overcomes various limitations of single-incision laparoscopic cholecystectomy (SILC), it is associated with high cost. In this study, we intended to investigate if SIRC is recommendable and advantageous to patients despite its high cost.Materials and Methods:We prospectively collected and analysed data of patients who had undergone either SILC (n = 25) or SIRC (n = 50) for benign gallbladder diseases, with identical inclusion criteria, between November 2017 and February 2019.Results:SILC and SIRC showed similar operative outcomes in terms of intra- and post-operative complications and verbal numerical rating scale (VNRS) for pain. However, the SIRC group exhibited significantly longer operation time than the SILC group (83.2 ± 32.6 vs. 66.4 ± 32.8, P = 0.002). The SIRC group also showed longer hospital stay (2.4 ± 0.7 vs. 2.2 ± 0.6, P = 0.053). Although the SILC and SIRC groups showed no significant difference in VNRS, the SIRC group required a higher amount (126.0 ± 88.8 mg vs. 87.5 ± 79.7 mg, P = 0.063) and frequency (3.0 ± 2.1 vs. 2.0 ± 1.8, P = 0.033) of intravenous opioid analgesic administration. During surgery, the critical view of safety (CVS), the prerequisite for safe cholecystectomy, was identified in only 24% (n = 6) of patients undergoing SILC and in 100% (n = 50) of patients undergoing SIRC (P < 0.05).Conclusion:We conclude that although SILC and SIRC have similar operative outcomes, SIRC is advantageous over SILC because of its potential to markedly enhance the safety of patients by proficiently acquiring CVS.

Stray energy transfer in single-incision robotic surgery.

Stray energy transfer from surgical monopolar radiofrequency energy instruments can cause unintended thermal injuries during laparoscopic surgery. Single-incision laparoscopic surgery transfers more stray energy than traditional laparoscopic surgery. There is paucity of published data concerning stray energy during single-incision robotic surgery. The purpose of this study was to quantify stray energy transfer during traditional, multiport robotic surgery (TRS) compared to single-incision robotic surgery (SIRS). An in vivo porcine model was used to simulate a multiport or single-incision robotic cholecystectomy (DaVinci Si, Intuitive Surgical, Sunnyvale, CA). A 5s, open air activation of the monopolar scissors was done on 30W and 60W coag mode (ForceTriad, Covidien-Medtronic, Boulder, CO) and Swift Coag effect 3, max power 180W (VIO 300D, ERBE USA, Marietta, GA). Temperature of the tissue (°C) adjacent to the tip of the assistant grasper or the camera was measured with a thermal camera (E95, FLIR Systems, Wilsonville, OR) to quantify stray energy transfer. Stray energy transfer was greater in the SIRS setup compared to TRS setup at the assistant grasper (11.6 ± 3.3°C vs. 8.4 ± 1.6°C, p = 0.013). Reducing power from 60 to 30W significantly reduced stray energy transfer in SIRS (15.3 ± 3.4°C vs. 11.6 ± 3.3°C, p = 0.023), but not significantly for TRS (9.4 ± 2.5°C vs. 8.4 ± 1.6°C, p = 0.278). The use of a constant voltage regulating generator also minimized stray energy transfer for both SIRS (0.7 ± 0.4°C, p < 0.001) and TRS (0.7 ± 0.4°C, p < 0.001). More stray energy transfer occurs during single-incision robotic surgery than multiport robotic surgery. Utilizing a constant voltage regulating generator minimized stray energy transfer for both setups. These data can be used to guide robotic surgeons in their use of safe, surgical energy.

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.

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

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-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.

Single-incision Robotic Cholecystectomy: Initial Experience and Results

Single-incision Robotic Cholecystectomy: Initial Experience and Results

Single-incision Robotic Cholecystectomy: Initial Experience and Results

Single-incision Robotic Cholecystectomy: Initial Experience and Results

Single-incision robotic cholecystectomy: A special emphasis on utilization of transparent glove ports to overcome limitations of single-site port.

The current robotic platform overcomes some limitations of single-incision laparoscopic cholecystectomy (SILC), however, whether robotic surgery is a safe and feasible approach must be investigated. Patients referred for elective surgery willing to undergo single-incision robotic cholecystectomy (SIRC) by consent were enrolled. All procedures were performed by the same team using the same surgical equipment. Thirty patients underwent SIRC. The mean overall operation time was 53.80±15.20min (range 32-80) and mean console time was 16.67±5.63min (range 11-30). The mean postoperative stay was 1.30±0.54days (range 1-3). There were no perioperative major complications. SIRC can be rapidly learnt and safely performed while overcoming the ergonomic difficulties encountered during SILC. SIRC can be a viable alternative treatment for gallbladder diseases in selected patients with strong interest in cosmetic outcomes who are willing to pay the higher costs associated with SIRC.

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.