Single-port Laparoscopic Cholecystectomy Research Articles

Clinical application of magnetic anchor technique in laparoscopic cholecystectomy: the first retrospective study in China.

Magnetic anchor technique (MAT) is frequently used in laparoscopic cholecystectomy. However, there are few reports on its clinical application in China. In this study, we retrospectively analyzed the clinical application of MAT in laparoscopic cholecystectomy in China. 25 patients (4 males, 21 females) who underwent laparoscopic cholecystectomy assisted by MAT at the First Affiliated Hospital of Xi'an Jiaotong University were enrolled from November 2020 to March 2021. Their records were retrospectively analyzed. The magnetic anchor device was independently designed and developed by the authors and consisted of the anchor magnet and magnetic grasping apparatus. Surgical time, intraoperative blood loss, intraoperative accidents, operator experience, postoperative incision pain score, postoperative complications, and other indicators were evaluated and analyzed. All patients successfully underwent laparoscopic cholecystectomy, including 3 cases of MAT-assisted transumbilical single-port LC, 16 cases of MAT-assisted 2-port LC and 6 cases of conventional 3-port LC. The median operation time was 50 min (range 30-95 min); intraoperative bleeding was less than 30 ml. The median score of surgical incision on day 1 and 3 after the operation was 3 (range 1-4) and 1 (range 1-3), respectively. All patients had no intraoperative bile duct injury, vascular injury, postoperative bleeding, bile leakage, biliary stricture and other complications. No adverse events (such as injury to adjacent organs or failure of the magnetic anchor device) occurred either during or after the operation. The MAT-assisted laparoscopic cholecystectomy appears to be safe, feasible and effective and exhibits unique assistance in transumbilical single-port laparoscopic cholecystectomy.

Impact of patient body mass index on surgical outcome after single port laparoscopic cholecystectomy

Impact of patient body mass index on surgical outcome after single port laparoscopic cholecystectomy

Propensity score matching analysis of perioperative outcomes including quality of life after multi-port vs. single port laparoscopic cholecystectomy: a nationwide prospective multicenter study in Korea

Introduction The usefulness of single-port laparoscopic cholecystectomy (SPLC) as compared to multi-port laparoscopic cholecystectomy (MPLC) remains controversial. Between SPLC and MPLC, we compared outcomes, especially subjective aspects, such as quality of life (QoL). Material and methods This multi-center study, involving 20 institutions from 2016 to 2017, enrolled 2507 patients who underwent laparoscopic cholecystectomy. Various perioperative outcomes, pain assessed by the numeric rating scale (NRS) score, and QoL evaluated by the gastrointestinal QoL index (GIQLI) questionnaire, were compared between the two procedures. We generated balanced groups after propensity score matching (PSM) using preoperative factors that influence the decision to perform MPLC or SPLC. Results MPLC and SPLC were performed in 2176 and 331 patients, respectively. Nine hundred and twelve and 329 patients, respectively, were selected from the two groups by PSM. Operation time was longer and surgical difficulty was lower in SPLC. There were no significant differences in most outcomes, including biliary complications. Significant superiority of SPLC over MPLC was shorter hospitalization, lower NRS score, and favorable GIQLI. Conclusions From nationwide prospective data, SPLC showed outcomes comparable to MPLC. In SPLC, morbidity was not high and postoperative QoL was favorable. In the future, more implementations and studies are needed to ensure the safety and feasibility of SPLC.

Single-port transumbilical pediatric cholecystectomy: any benefits for the patient?

To compare the perioperative results of single-port laparoscopic cholecystectomy (SPLC) with those of laparoscopic cholecystectomy (LC), and to analyze whether there were any differences between both techniques in our patients. A retrospective, observational analysis was carried out in non-homogeneous groups of patients under 15 years of age undergoing LC and SPLC over a 6-year period. LC was conducted using four ports, while SPLC was performed through an umbilical incision using a wound retractor to which a surgical glove was coupled for the insertion of 3 ports and instruments curved as required. 15 clinical, surgical, and economic variables were compared by means of a univariate and bivariate analysis. 11 patients underwent surgery - 5 through SPLC and 6 through LC. No significant differences were found in terms of mean operating time (SPLC: 144 minutes vs. LC: 139, P= 0.855) or hospital stay, but a slight increase in hospital cost was noted (SPLC: 1,160 € vs. LC: 1,177 €). The cost of LC was 1,322 € vs. 1,367 € for SPLC, with a premium of 44.30 € owing to the use of the wound retractor. None of the patients had perioperative complications, and all of them felt the cosmetic result was excellent. In our limited experience, the differences between SPLC and LC do not clearly support one or the other. SPLC could provide patients with a better cosmetic result and allow surgeons to improve their skills. However, we believe cholecystectomy is not the most adequate procedure to start a career in single-port laparoscopy because potential complications may be severe.

Our initial single port robotic cholecystectomy experience: A feasible and safe option for benign gallbladder diseases.

Although single-port laparoscopic cholecystectomy has been performed for over 25 years, it is still not popular. The narrow working space used in this surgery limits the movement of instruments and causes ergonomic challenges. Robotic surgery not only resolves the ergonomic challenges of single-port laparoscopic surgery but is also considered a good option with its additional technical advantages, like a three-dimensional display and not being affected by tremors. However, the extent to which these technical and ergonomic advantages positively affect the surgical outcomes and how safe the single-port robotic surgeries need to be assessed for each particular surgery. To evaluate the feasibility and safety of single-port robotic cholecystectomy for patients with cholelithiasis. The electronic records of the first 40 consecutive patients with gallbladder lithiasis who underwent single-port robotic cholecystectomy from 2013 to 2021 were analyzed retrospectively. In addition to the demographic characteristics of the patients, we analyzed American Society of Anesthesiologists (ASA) scores and body mass index. The presence of an accompanying umbilical hernia was also noted. The amount of blood loss during the operation, the necessity to place a drain in the subhepatic area, and the need to use grafts during the closure of the fascia of the port site were determined. Hospital stay, readmission rates, perioperative and postoperative complications, the Clavien-Dindo complication scores and postoperative analgesia requirements were also evaluated. The mean age of the 40 patients included in the study was 49.5 ± 11.6 years, and 26 were female (65.0%). The umbilical hernia was present in 24 (60.0%) patients, with a body mass index median of 29.3 kg/m2 and a mean of 29.7 ± 5.2 kg/m2. Fifteen (37.5%) of the patients were evaluated as ASA I, 18 (45.0%) as ASA II, and 7 (17.5%) as ASA III. The mean bleeding amount during the operation was 58.4 ± 55.8 mL, and drain placement was required in 12 patients (30.0%). After port removal, graft reinforcement during fascia closure was preferred in 14 patients (35.0%). The median operation time was 93.5 min and the mean was 101.2 ± 27.0 min. The mean hospital stay was 1.4 ± 0.6 d, and 1 patient was readmitted to the hospital due to pain (2.5%). Clavien-Dindo I complications were seen in 14 patients (35.0%), and five (12.5%) complications were wound site problems. In addition to the technological and ergonomic advantages robotic surgery provides surgeons, our study strongly supports that single-port robotic cholecystectomy is a feasible and safe option for treating patients with gallstones.

Experience of single port laparoscopic cholecystectomy in primary clinic

Experience of single port laparoscopic cholecystectomy in primary clinic

Review of 3,665 cases of single port laparoscopic cholecystectomy performed in 7 years in single community hospital by single surgeon

Review of 3,665 cases of single port laparoscopic cholecystectomy performed in 7 years in single community hospital by single surgeon

Single-Port Cholecystectomy for Cholecystitis Versus Non-Cholecystitis.

Background and Objectives:To assess the safety and efficacy of single-port laparoscopic cholecystectomy (SPLC) for the treatment of symptomatic cholelithiasis in different gallbladder pathologic conditions.Methods:All patients who underwent SPLC in our department between October 1, 2017 and March 31, 2020 were registered consecutively in a prospective database. Patients’ charts were retrospectively divided according to histological diagnosis: normal gallbladder (NG) (n = 13), chronic cholecystitis (CC) (n =47), and acute cholecystitis (AC) (n = 10). The parameters for assessing the procedure outcome included operative time, blood loss, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and length of hospital stay. Patient groups were statistically compared.Results:Seventy patients underwent SPLC. Duration of surgery increased from NG (55 ± 22.7 min) to CC (70 ± 33.5 min), and to AC patients (110.5 ± 50.5 min), which is statistically significant (P = .001). Postoperative complication rates were 7.6% in NG patients, 17% in CC, and 30% in AC (P = .442). Length of hospitalization was shorter for NG patients (1.0 ± 0.6 days) versus CC (2.0 ± 1.1 days) and AC patients (2.0 ± 4.7 days), with statistical significance (P = .020). Multivariate analysis found that pathology type and the occurrence of postoperative complications were independent predictors for prolonged operative times and prolonged hospital stay, respectively.Conclusion:SPLC is feasible for acute and chronic cholecystitis with good procedural outcomes. Since SPLC technique itself can be sometimes challenging with the existing technology, its application, especially in cases of acute cholecystitis, should be done with caution. Only prospective randomized studies on this approach for acute and chronic gallbladder diseases will assess the complete reliability of this technique.

Gasless single-port laparoscopic cholecystectomy.

PurposeSingle-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single port at the umbilicus and using the abdominal wall-lifting method, without establishing pneumoperitoneum.MethodsRetrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection.ResultsThe SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m2. The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups.ConclusionThe impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.

Minimally Invasive Cholecystectomy: Transvaginal or Transabdominal Approach—Which Technique Is Preferred by Female Hospital Employees?

Background: Evidence is lacking concerning a clear benefit of single-port laparoscopic cholecystectomy (SILC) and transvaginal cholecystectomy (TVC) over the classical laparoscopic cholecystectomy (CLC). In this study, we investigated the preferences of the operation techniques among female employees in a tertiary university clinic. Materials and Methods: Study participants in the department of general surgery and gynecology were interviewed regarding their personal felt preferences for the mentioned procedures using a standardized illustrated questionnaire. Results: A total of 111 participants were included in the study. In 70.3% of cases, the transvaginal approach was unknown. The classical techniques were preferred in 95.2% of respondents. Participants with a wish for children showed a higher preference for nontransvaginal techniques (P = .011). The acceptance rate of transvaginal techniques among employees of the department of gynecology was higher than those of the department of general surgery (P = .028). Conclusions: The overall acceptance rate for TVC is low. Especially in case of a wish for children, SILC and CLC represent the preferred techniques. The lack of popularity of TVC could be an explanation for the refusal of this technique. Among employees of the gynecologic department, a transvaginal approach was significantly more often accepted. The cosmetic outcome and the knowledge about an operation technique certainly influence the decision making for the preferred surgical method.

Breast cancer with asymptomatic metastasis to the gallbladder

Breast cancer is the most frequent malignant tumors among female and it is usually associated with metastasis to lungs, bones, liver, and brain. The gallbladder as the site of metastasis from breast carcinoma is extremely rare, and only a few such case reports have been published to date. We report the case of a 59-year-old woman diagnosed with breast cancer who underwent cholecystectomy for an incidental finding of gallbladder wall thickening on computed tomography. A 59-year-old menopausal woman presented with a lump in her right breast for one months. Breast examination revealed an ill-defined palpable area in the right breast. Ultrasonography (US) of the right breast revealed 28 mm × 19 mm sized irregular hypoechoic mass in the retro-areolar area. This was followed by a US-guided Tru-cut biopsy of the right breast lesion and axillary nodes, which revealed invasive lobular carcinoma. The tumour was positive for oestrogen receptors. Computer tomography showed a wall a thickening in the fundus and body of the gallbladder with multiple gallstones. A single port laparoscopic cholecystectomy was performed, and the postoperative course was uneventful. Histopathology of the gallbladder revealed involvement by an invasive lobular carcinoma. Metastatic gallbladder involvement is rare, especially in a case of primary breast cancer and It is difficult to suspect a metastatic localization from primary breast cancer in the breast cancer. Even if there is no gastrointestinal symptoms, it is necessary to be well aware of the possibility of metastasis in patients with if imaging reveals gallbladder abnormalities.

Is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain?

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain? Using the reported search, 8083 papers were found. 8 studies were deemed to be suitable to answer the question. The outcomes assessed were post-operative pain differ in single or standard laparoscopic cholecystectomy, all study used VAS (visual analogue scale). The evidence showed no difference in post-operative pain for patients went for single laparoscopic in compared with standard laparoscopic cholecystectomy.

Single-Port Laparoscopic Cholecystectomy Assisted with Neodymium Magnets: Initial Prospective Experience with 60 Cases

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard performed by the majority of surgeons worldwide, and the use of single-port cholecystectomy remains a matter of debate. Single-port magnetic-assisted cholecystectomy (SPMAC) was described as an alternative because of its ability for proper triangulation and the advantage of reducing port surgery. The objective of this study is to describe the initial experience of SPMAC and evaluate the surgical learning curve. Materials and Methods: A prospective cohort was conducted between February 2017 and August 2018; 60 patients completed the inclusion criteria. Variables analyzed were gender, age, body mass index, American Society of Anesthesiologist (ASA) classification, operative time, hospital stay, intraoperative bleeding, and conversion rate. Postoperative pain was measured with a visual analogue scale (VAS). Aesthetic perception was measured by the cosmetic visual analogue scale (CVAS). The postoperative complications were graded according to Clavien-Dindo classification, and the cumulative sum (CUSUM) model was used for evaluating the learning curve. Results: The mean operatory time was 56.1 minutes. With regard to the postoperative pain variable, the VAS value was 2 out of 10 in 78.33% of patients. With regard to aesthetic satisfaction, CVAS was reported to be 10 out of 10 in 96.67% of patients. Conversion rate was 0%. The learning curve of operative time was reached at the 22nd patient, according to the CUSUM chart. Conclusions: SPMAC is feasible and effective; in our consideration, an acceptable learning curve considering benign gallbladder pathology is one of the most prevalent in general surgery. Further comparative studies with conventional LC and SPMAC need to be performed to conduct a proper comparison.

Readmission to hospital following laparoscopic cholecystectomy: ameta-analysis.

Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures. Despite this, patterns of readmission following LC are not well defined. This meta-analysis aimed to determine rates and predictors of readmission. An ethically approved International Prospective Register of Systematic Reviews (PROSPERO)-registered meta-analysis was undertaken searching PubMed, Scopus, Web of Science and Cochrane Library databases from January 2013-June 2018 adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Published literature potentially suitable for data analysis was graded using methodological index for non-randomised studies (MINORS) criteria; papers scoring ≥ 16/24 for comparative and ≥ 10/16 for non-comparative studies were included. A meta-analysis of potential risk factors was performed by computing the odds ratio using Mantel-Haenszel method and fixed-effects model with 95% confidence intervals. Three thousand and eight hundred thirty-two articles were reduced to 44 studies qualifying for a final analysis of 1,573,715 laparoscopic cholecystectomies from 25 countries. Overall readmission rate was 3.3% (range: 0.0-11.7%); 52,628 readmissions out of 1,573,715 LCs. Surgical complications accounted for 76% of reported reasons for readmission, predominantly bile duct complications (33%), wound infection (17%) and nausea and vomiting (9%). Pain (15%) and cardiorespiratory complications (8%) account for the remainder. Obesity, single port LC and day case LC were not associated with increased rates. Pain, nausea and vomiting and surgical complications, particularly bile duct obstruction are the most common causes for readmission. Intra-operative cholangiography may reduce readmission rates. Causes for readmission were inconsistently reported throughout. The mean readmission rate of 3.3% may act as a quality benchmark for improving LC, and clearer reporting of reasons for readmission are required to advance care.

Transumbilical single-port laparoscopic cholecystectomy for chronic cholecystitis with cholecystolithiasis

Objective To study the feasibility, safety and aesthetics of laparoscopic cholecystectomy using a single-port through the umbilicus in patients with chronic cholecystitis with cholecystolithiasis. Methods From Jan 2007 to Jun 2017, the clinical data of 4790 patients who underwent single-port, 4 426 patients conventional three-ports, and 3 304 patients two-ports laparoscopic cholecystectomy were retrospectively studied. Results There were no death in all the three groups. There were no significant differences in the incidences of postoperative bleeding, bile leakage, biliary tract injury and other significant short-term complications (all P>0.05). The operation time of transumbilical single-port laparoscopic cholecystectomy was significantly longer than that of two-ports and three-ports laparoscopic cholecystectomy [(35.3±9.0)min vs. (28.4±7.2)min vs. (23.3±6.4)min, P 0.05). There were no significant differences among the three groups in intraoperative blood loss, first postoperative passing of flatus, postoperative pain, and length of hospital stay (all P>0.05). The satisfaction score of surgical scar in the single-port group was higher than that in the two-ports and three-ports groups [(9.6±1.6) vs. (7.6±1.9) vs. (6.7±2.0), P<0.05]. Conclusions Transumbilical single-port laparoscopic cholecystectomy was safe and feasible, with good aesthetics and other advantages. It was more difficult than the traditional laparoscopic technique. After the learning curve, the operation time could be comparable to the three-ports technique. Key words: Cholecystectomy, laparoscopic; Cholecystolithiasis; Cholecystitis; Transumbilical single-port laparoscopy

Minimally Invasive Single-Site Cholecystectomy in Obese Patients: Laparoscopic vs. Robotic.

PurposeLaparoscopic cholecystectomy is treatment method for management of benign gallbladder diseases. Further attempts are made to operate single-port laparoscopic cholecystectomy. However, single-port laparoscopic cholecystectomy, the procedure remains technically difficult, especially in obese patient. Recently, a robotic surgical system for minimal invasive surgery was introduced to overcome the limitations of conventional laparoscopic surgery.MethodsFrom April 2009 to August 2017, we retrospectively reviewed the medical records of patients with single-site, minimally invasive (laparoscopic and robotic) cholecystectomy with high BMI (>25 kg/m2). We analyzed general characteristics and perioperative outcomes between the single-fulcrum laparoscopic cholecystectomy group and the robotic single-site cholecystectomy (RSSC) group.ResultsOperation time (57.56±11.10 vs 98.5±12.28 p<0.001) was significantly longer and postoperative pain score (3.61 vs 5.15 p=0.000) was significantly higher in the robotic single-site cholecystectomy (RSSC) group, but the actual dissection time (25.85±11.09 vs 25.79±13.35 p=0.978) was not significantly different between the two approaches. Iatrogenic gallbladder perforation, (13 vs 6 p=0.005), patients undergoing RSSC showed a significantly smaller amount than did those undergoing single-fulcrum laparoscopic cholecystectomy (SFLC).ConclusionIt is difficult to say for certain that RSSC is clearly better than SFLC in obese patients. However, because of the technical convenience and efficiency of surgery with RSSC, RSSC can be practically worthwhile. Further study is mandatory.

Single-Port Versus Conventional Laparoscopic Cholecystectomy: Better Cosmesis at the Price of an Increased Incisional Hernia Rate?

Background: The incidence of trocar site hernia (TSH) in single-port laparoscopic cholecystectomy (SPC) is still a debated issue. Aim of this retrospective study was to compare the incidence of postoperative hernia and cosmetic results among patients undergoing SPC and multiport laparoscopic cholecystectomy (MPC) performed at a single institution. Methods: A series of 60 SPC and 60 MPC patients operated on between July 2016 and May 2018 were compared. Primary endpoint was to assess the incidence of TSH at long term. All the patients were admitted as outpatients for physical examination and scar measurement. Secondary endpoints were the cosmetic results assessed by a cosmesis score (CS) and the body image questionnaire (BIQ). Results: After a median 18-month follow-up (range: 6-29 months), a hernia in umbilical trocar site was detected in 4 (7.1%) SPC patients and 1 (2%) MPC patient, the difference not being statistically significant (P = .216). BIQ was almost equivalent in SPC and MPC groups (5.15 versus 5.27; P = .518), respectively. Statistically significant differences in favor of SPC were found in CS (22.3 versus 19.72; P = .001) and in total length of scars (1.2 cm versus 4 cm; P < .001). Conclusions: SPC technique has proved to be safe and effective in experienced hands. Superior cosmesis of SPC over MPC is confirmed, but close attention to fascial closure is a vital component of SPC, and surgeons performing single-site surgery need to be aware of this increased potential for hernia formation.

Single port laparoscopic cholecystectomy compared to the standard laparoscopic cholecystectomy

Background: Efforts to improve outcomes of laparoscopic cholecystectomy heralded the advent of single incision laparoscopic cholecystectomy. The objective of this study was to evaluate and compare single port laparoscopic cholecystectomy to the standard laparoscopic cholecystectomy with respect to time required for surgery, postoperative pain, morbidity and complications.Methods: This comparative randomized study was conducted in M.L.B. Medical College, Jhansi among 124 patients. 74 patients were included in the three port laparoscopic cholecystectomy group and 50 in the single port laparoscopic cholecystectomy group. Informed consent was taken. All patients were operated under general anesthesia. Statistical analysis was using independent t-test and chi- square test.Results: The mean operative time was slightly longer in SILC (group I) as compared to CLC/SLC (group II). Postoperative pain on VAS scale in group I after 6 hours (1st day score) was 2.44 in group I and 2.73 in group II (CLC/SLC). But on 2nd day in SILC 1.40 and in CLC/SLC it was 1.81. In SILC (group I) 4 patients out of 50 (8%) developed seroma and 2 patients out of 50 (4%) developed Biliary peritonitis due to the slipped dip. And in SLC/CLC (group II) 3 patients out of 74 (4.05%) developed seroma.Conclusions: SILC can be an effective alternative to traditional CLC/SLC, with the added benefit of minimized scarring and a shorter length of stay. This technique can be performed safely for patients with a multitude of gallbladder diseases without resulting in additional complications.

Single-Port Laparoscopic and Robotic Cholecystectomy in Obesity (&gt;25 kg/m2)

Background and Objectives:Single-port cholecystectomy has emerged as an alternative technique to reduce the number of ports and improve cosmesis. Few previous studies have assessed obesity-related surgical outcomes following single-port cholecystectomy. In this study, technical feasibility and surgical outcomes of single-port laparoscopic cholecystectomy (SPLC) and robotic single-site cholecystectomy (RSSC) in obese patients were investigated.Methods:We conducted a two-center collaborative study and retrospectively reviewed initial experiences of RSSC and SPLC in patients whose body mass index was over 25 kg/m2. Medical records of patients were reviewed. Clinical characteristics and short-term oncologic outcomes were considered and compared between SPLC and RSSC groups.Results:RSSC and SPLC were performed in 39 and 78 patients, respectively. In comparative analysis, the total operative time was longer in the RSSC group (109.92 minutes vs. 60.99 minutes; P < .001).However, requiring additional port for completion of surgical procedure was less frequent in the RSSC group (0% vs. 12.8%; P = .029). Immediate postoperative pain score was not significantly different between the two groups (4.95 vs. 5.00; P = .882). However, pain score was significantly lower in the RSSC group at the time of discharge (1.79 vs. 2.38; P = .010). Conversion to conventional multiport cholecystectomy, intraoperative bile spillage, or complication rate was not significantly different between the two groups (P > .05).Conclusions:SPLC and RSSC could be safely performed in selected patients with high body mass index, showing no significant clinical differences.

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.