Single-site Robotic Cholecystectomy Research Articles

Advancing Robotic Single-Site Cholecystectomy: Innovations, Challenges, and Future Directions.

The crystalization of the components of bile within the gallbladder can lead to the formation of gallstones (cholelithiasis), which may often require surgical removal of the gallbladder, a procedure known as cholecystectomy, in symptomatic cases.Robotic single-site cholecystectomy (RSSC) is a recently introduced groundbreaking minimally invasive procedure for gallbladder removal. RSSC utilizes robotic technology, offering enhanced dexterity through a single-incision approach, promising improved outcomes such as reduced postoperative pain and superior cosmesis. However, certain limitations, such as restricted instrument movement and heightened hernia risk, necessitate a critical evaluation of this modality. Furthermore, as the widespread adoption of RSSC remains undecided due to concerns over its costs, efficiency, and overall superiority over prior models, this paper assesses future possibilities forRSSC's evolution. In vivo robotics, improved digital imaging, and re-engineering of the surgical instruments themselves are all potential avenues to augment the current RSSC design, although it is currently unclear as to what extent they could impact the procedure's viability. This review critically examines the available literature on the effectiveness and potency of RSSC compared to its predecessors in the modern healthcare setting and proposes future directions through which innovation could more firmly establish the procedure as the standard of care for cholecystectomy.

Comparative analysis of robotic single-site cholecystectomy outcomes between novice and expert surgeons.

Single-incision laparoscopic cholecystectomy (SILC) has declined in popularity, posing a challenge for novice surgeons. However, robotic single-site cholecystectomy (RSSC) has gained popularity in hepatopancreatic surgery, suggesting a paradigm shift in minimally invasive procedures due to the advantages of robotic platforms. The purpose of this study was to compare the surgical outcomes and learning curves between experts and novices without SILC experience, and discuss the utility and potential of RSSC for novice surgeons. A total of 235 patients underwent RSSC between April 2019 and June 2023 at the OOO University Hospital. Among them, 31 cases from novice and expert surgeons were selected to compare their initial experience. Comprehensive demographic and perioperative factors were analyzed and statistical comparisons were made, including cumulative sum analysis (CUSUM) for learning curves. The demographic factors showed no statistically significant differences between the two groups. Although the docking time (P < 0.001) and hospital stay (P = 0.014) were statistically significant, the total operative time and other perioperative factors were comparable. Novice surgeons demonstrated a shorter absolute total operative time, primarily attributed to differences in docking time. The CUSUM analysis indicated a shorter learning curve for novice surgeons. This study shows that the inherent benefits of the robotic platform make it an accessible and reproducible technique for novices. The benefits of integrating observational learning into robotic surgery training programs and the intrinsic advantages of the robotic platform in minimizing the learning curve for RSSC were also highlighted.

Effects of extremely low-pressure pneumoperitoneum on postoperative recovery after single site robot-assisted cholecystectomy: a randomized controlled trial.

A robotic platform has enabled extremely low-pressure pneumoperitoneum (ELPP, 4 mmHg) to reduce surgical insults to human physiology during a minimally invasive surgery. The objective of this study was to investigate the effect of ELPP in single-site robotic cholecystectomy (SSRC) on postoperative pain, shoulder pain, and physiological changes during surgery compared to a standard pressure pneumoperitoneum (SPP, 12-14 mmHg). A total of 182 patients who underwent an elective cholecystectomy were randomized into an ELPP SSRC group (n = 91) and an SPP SSRC group (n = 91). Postoperative pain was assessed at 6, 12, 24, and 48 h after surgery. The number of patients complaining of shoulder pain was observed. Intraoperative changes of ventilatory parameters were also measured. Postoperative pain scores (p = 0.038, p < 0.001, p < 0.001, and p = 0.015 at 6, 12, 24, and 48 h after surgery, respectively) and the number of patients with shoulder pain (p <0.001) were significantly lower in the ELPP SSRC group than in the SPP SSRC group. Intraoperative changes in peak inspiratory pressure (p < 0.001), plateau pressure (p < 0.001), EtCO2 (p < 0.001), and lung compliance (p < 0.001) were also less in the ELPP SSRC group. The ELPP during robotic cholecystectomy could significantly relieve postoperative pain and shoulder pain. In addition, the ELPP can reduce changes in lung compliance during surgery and the demand for postoperative analgesics, thereby improving the quality of life of patients during early stages of postoperative rehabilitation.

Single-site robotic cholecystectomy versus single-incision laparoscopic cholecystectomy: A systematic review and meta-analysis.

The possibilities of minimally invasive cholecystectomy have emerged since the beginning of single-incision laparoscopic cholecystectomy (SILC) and single-site robotic cholecystectomy (SSRC). This study aimed to compare the feasibility, safety, and pain scores between SSRC and SILC. The authors searched randomized or non-randomized controlled trials and observational studies in PubMed, EuroPMC, and ClinicalTrials.gov from April 2012 until April 2022. The authors analyzed the operation time, hospital stay, blood loss volume, conversion rate, intraoperative complication rates, postoperative complications, visual analog scale (VAS) immediately after surgery, and VAS at hospital discharge. This study aligned with PRISMA and AMSTAR guidelines. Thirteen studies were selected with 817 and 757 patients who underwent SSRC and SILC. Thus, this study demonstrated a lower incidence of intraoperative complication rates [relative risk (RR) 0.57 (95% CI 0.34-0.96), p = 0.03] and lesser VAS score at hospital discharge [Std. Mean Difference (SMD) -0.23 (95% CI -0.46, -0.01), p = 0.04] in the SSRC group. Regarding operation time and cost, SSRC revealed a longer time [SMD 1.02 (95% CI 0.45, 1.59), p = 0.0004] and higher cost [SMD 4.18 (95% CI 1.77, 6.58), p < 0.00001], respectively. Meanwhile, SSRC did not differ from SILC during a hospital stay, blood loss volume, conversion rate, postoperative complication rates, and VAS immediately after surgery. Concerning intraoperative complication rates and VAS score at hospital discharge, SSRC was superior to SILC. Thus, SSRC is considered a feasible and safe procedure.

Comparison of robotic single site cholecystectomy and conventional laparoscopic cholecystectomy using propensity score matching

Comparison of robotic single site cholecystectomy and conventional laparoscopic cholecystectomy using propensity score matching

Learning Curve of Single-site Robotic Cholecystectomy: A Cumulative Sum Analysis.

Minimally invasive surgery has significantly improved cosmesis and clinical outcomes after either laparoscopic or robotic cholecystectomy. In an effort to minimize the number of incisions in multiport procedures, single-site approaches have been developed. However, single-site robotic cholecystectomy (SSRC) can be technically challenging for novice surgeons. The goal of this study is to establish the learning curve (LC) of SSRC through an assessment of operative times and clinical outcomes. A retrospective analysis of patients undergoing SSRC over a period of 5 years was performed. Consecutive cholecystectomy cases were assessed based on the procedure setting (elective vs. emergent). Cumulative sum analysis were used to establish the LC through an evaluation of the skin-to-skin (STS) time and postoperative complications rate. Afterward, a direct comparison was performed between the established phases. This study included a total of 259 SSRCs with an overall mean STS time of 41.1 minutes. Elective cases took on average of 38.8 minutes, whereas emergent cases spanned over 60.5 minutes ( P= 0.005). The cumulative sum-LC was obtained by summing the differences between each procedure's STS time, revealing a quadratic best-fit line maximum and an inflection point between the early and late phases at case 91. A significant difference between STS time was seen between the early and late phases (53.8 vs. 30.0min, P< 0.0001). There were no significant differences in terms of postoperative complications between the 2 phases. Incisional hernia rates were comparable between the 2 phases (early: 4.4% vs. late: 2.5%, P< 0.461). This is the largest study to assess the LC of SSRC through operative time and clinical outcomes. A steady decrease in STS time was observed during the completion of the first 91 consecutive cases.

Robotic single-site cholecystectomy is better in reducing postoperative pain than single-incision and conventional multiport laparoscopic cholecystectomy.

To compare the short-term outcomes of robotic single-site cholecystectomy (RSSC) with single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC), focusing on postoperative pain outcomes. This single-center retrospective study included consecutive patients with benign gallbladder disease who underwent cholecystectomy by a single surgeon between June 2019 and December 2021. Exclusion criteria were acute cholecystitis (AC) and other combined surgeries. One-to-one propensity score matching was performed between the RSSC and SILC or CMLC. Of the 157 patients included, 39 (24.8%) underwent RSSC, 32 (20.4%) underwent SILC, and 86 (54.8%) underwent CMLC. In a propensity score-matched cohort between RSSC and SILC (32 patients in each group), the number of additional analgesic injections was significantly lower in the RSSC group than in the SILC group (0.7 vs. 1.3, p = 0.002), and postoperative pain scores were also significantly lower at 6h (2.8 vs. 3.6, p = 0.004) and 24h (2.6 vs. 3.3, p = 0.021) after surgery in the RSSC group than in the SILC group. In a propensity score-matched cohort between RSSC and CMLC (23 patients in each group), the number of additional analgesic injections was significantly lower in the RSSC group than in the CMLC group (0.7 vs. 1.3, p = 0.005), and postoperative pain scores were also significantly lower at 6h after surgery (2.9 vs. 3.7, p = 0.025) in the RSSC group than in the CMLC group. This study demonstrated that RSSC is helpful in reducing postoperative pain and the use of additional analgesics compared to both SILC and CMLC.

Propensity Score Matched Comparison of Robotic Single-Site and Laparoscopic Cholecystectomy.

To demonstrate the feasibility and potential of robotic single-site cholecystectomy, the study aimed to compare it with conventional laparoscopic cholecystectomy. In total, 791 consecutive patients underwent conventional laparoscopic cholecystectomy or robotic single-site cholecystectomy at our center between 2019 and 2022. After 1:1 propensity score matching, 117 patients for each group were selected. After propensity score matching, the only statistically significant difference between conventional laparoscopic cholecystectomy and robotic single-site cholecystectomy was operative time, which was 29.15 ±11.45 min in the conventional laparoscopic cholecystectomy group versus 38.57 ± 12.59 min in the robotic single-site cholecystectomy group (P < 0.001). Because the difference in surgical time between the two groups was minimal, it has little clinical relevance. Using cumulative sum analysis, the maturation phase of the total operation and docking times occurred after the 53rd case. To reduce bias, a comparison of results with conventional laparoscopic cholecystectomy and cases of robotic single-site cholecystectomy was performed in the maturation phase, which revealed only total operative time as statistically significant (P < 0.001). Robotic single-site cholecystectomy is a technically feasible and safe method for treating benign gallbladder diseases, with a relatively short learning curve and reasonable operative time.

“New is always better”: Single center experience of over 300 cases of robotic single site cholecystectomy comparing the new da Vinci SP with the previous Si/Xi systems

“New is always better”: Single center experience of over 300 cases of robotic single site cholecystectomy comparing the new da Vinci SP with the previous Si/Xi systems

“New is always better”: Single center experience of over 200 cases of robotic single site cholecystectomy comparing the new da Vinci SP with the previous Si/Xi systems

The da Vinci surgical system released its new pure single-port platform, the da Vinci SP, offering improvements and refinements such as articulating instruments for established robotic single-site procedures. We describe our institution's experience with robotic single site cholecystectomy utilizing the new da Vinci single-port (SP) robotic system and compare the results with the previous da Vinci Si/Xi system. We reviewed the medical records and compared the perioperative outcomes of patients who underwent robotic single site cholecystectomy using the da Vinci SP model with the previous Si and Xi models. Of the 238 patients, there were 120 and 118 patients in the SP and Si/Xi group, respectively. The mean age of patients in the SP group was 48.7 years which was significantly higher than the Si/Xi group (p = 0.002). However, the BMI of patients in both groups was similar. In both groups, the most common indication for cholecystectomy was gallbladder stone. However there more patients diagnosed with acute cholecystitis in the SP group (4.2%). The mean docking time (3.20 ± 1.40 min), console time (21.63 ± 13.34 min) and total operative time (48.42 ± 18.33 min) was significantly shorter in the SP group. However the conversion rate, complication rate and hospital stay was similar between the 2 groups. Robotic single site cholecystectomy using da Vinci SP is safe and feasible. Due to its refinements, it requires less time for preparation and operation than the previous Si or Xi models and has showed promise to include more challenging indications such as acute cholecystitis.

Safety of single incision laparoscopic cholecystectomy using Gloveport and easy conversion technique to one additional port

Our center successfully incorporated the alignment of the instruments in robotic single-site cholecystectomy into single incision laparoscopic cholecystectomy (SILC). Since then, SILC has been applied to almost all cases involving gallbladder except for malignancies. SILC can also be applied to complicated cases with the use of additional port as a safe alternative. We introduce our experience of implementing easy conversion of one additional port during SILC. Between March 2014 and December 2020, 1,126 patients underwent SILC in our center by 3 hepatobiliary surgeons. The indication included benign diseases of gallbladder. When conversion was needed, one additional port was inserted at subxiphoid area. Perioperative outcomes were reviewed. 440 males and 686 females were included in this study. The mean age was 47.9 ± 13.4 years, mean body mass index was 24.6 ± 3.6 kg/m2, and mean operative time was 47.6 ± 17.3 minutes. Total number of 67 patients (6.0%) were required to one additional port, of which 41 patients due to Calot's triangle adhesion, 14 patients due to uncontrolled bleeding at Calot's triangle, 9 patients due to severe inflammation, and 3 patients due to poor operation field. Based on our vast number of cases of SILC no matter how complicated the case, one subxiphoid additional port can be a safeguard to SILC. Therefore, bear in mind SILC can be endeavored by all surgeons with the use of additional port as a safe alternate.

Early Outcomes of Robotic Single Site Cholecystectomy Using the DaVinci Xi® System.

Purpose:Robotic surgery has become an established alternative to conventional laparoscopy or single site laparoscopy by solving the problems of angulation, improving the ergonomics of single-incision technology, and overcoming the intrinsic limitations of single-incision laparoscopy. Although the robotic single site technology is non-wristed and, unlike other conventional robotic instruments, only provides rotation, the ergonomics are nevertheless excellent. Therefore, the objective of this study is to present our initial experience in robotic single site cholecystectomy (RSSC) by a surgeon. Through this, we suggest that RSSC could be a feasible and safe procedure for overcoming the shortcomings of single incision laparoscopic cholecystectomy (SILC).Methods:This study is a retrospective data review of 74 patients who underwent RSSC between April 2019 and August 2020 at our institution. The demographic, pre-, and postoperative data were retrospectively collected.Results:A total of 74 patients underwent RSSC. The mean age of patients was 44.7 ± 9.5 years, and their mean body mass index was 24 ± 3 kg/m2. Symptomatic gallbladder stone (56.8%) was the most common pre-operative diagnosis. Mean of total operation and docking times was 39.3 ± 12.5 (20 – 85) and 7.6 ± 3.1 (4 – 20) minutes, respectively. There was no conversion, additional port insertion, bleeding, or intra-operative complication; however, one patient had wound seroma.Conclusions:RSSC for uncomplicated gallbladder disease may serve as an excellent alternative to SILC or conventional laparoscopic cholecystectomy because of its low complication rates, good cosmesis, and ease of reproducibility without a substantial learning curve.

Does an Experienced Laparoscopic Surgeon Need a Long Learning Curve to Start Robotic Single Site Cholecystectomy?

Purpose: It is well known that a laparoscopic single site cholecystectomy has significant limitations associated with proper triangulation and instrument crowding and collisions. Although the da Vinci Single Site robotic system has been proposed to overcome these problems, the Single Site technology is non-wristed and, unlike other conventional robotic instruments, only provides rotation, the ergonomics. Therefore, many surgeons are reluctant to start robotic single site cholecystectomy (RSSC). The purpose of this study is to demonstrate that an experienced laparoscopic surgeon can safely RSSC with less learning curves using the robotic single site platform by showing objective data by single experienced surgeon.

Outcome after single-site robotic cholecystectomy: An initial single center's experience.

Although laparoscopic cholecystectomy (LC) is the gold standard for symptomatic gallbladder disease, a single-incision approach may be a new challenge in order to achieve minimization of surgical trauma. Single-site robotic cholecystectomy (SSRC) is able to offset the ergonomic limitation of laparoscopic single-site cholecystectomy and improves cosmesis. We present a single-institution initial experience of SSRC for cholecystolithiasis. Intra-operative and post-operative data of patients were reviewed to assess the technical feasibility and cosmetic outcome. We evaluated a series of 27 consecutive patients retrospectively analyzed and prospectively collected who underwent SSRC. One patient was excluded from the final analysis because they converted to open procedure. The female/male ratio was 17/9, with mean age of 48 ± 12 years. The body mass index mean value was 26.0 ± 4.2. The mean operative time was 99.6 ± 21.5minutes. No intra- or post-operative complications and readmissions were recorded. At 12 months follow up, every patient received the Body Image Questionnaire (BIQ) and a Photo Series Questionnaire. We recorded three patients (11.5%) with post-operative incisional hernia. Scores of the BIQ subscale for body image perception were 6 ± 1.2, while the scores of scar cosmesis were 21.1 ± 3.0. A statistically significant improvement in scar self-rating from T0 to T1 (P < .01) was found. In our initial experience SSRC may be preferred to treat patients with higher needs in terms of cosmesis and body image perception. Lower costs for rent, maintenance and consumables may allow the spread of robotic surgery also for singe site cholecystectomy.

Robotic single-site cholecystectomy for a symptomatic duplicated gallbladder

Abstract Duplicated gallbladders are relatively rare congenital anomalies. Their unique anatomy provides anatomical challenges that should be considered at the time of imaging and at the time of surgery. We present a case report of a patient with biliary colic who was found to have a duplicated gallbladder on imaging. This is the first reported pediatric patient to have undergone a robotic single-site cholecystectomy for a duplicated gallbladder.

Robotic multiport versus robotic single-site cholecystectomy: a retrospective single-centre experience of 142 cases

Robotic cholecystectomy with the da Vinci Xi® system (Intuitive Surgical, Sunnyvale, CA, USA) can be performed either as a multiport or a single-incision procedure with the da Vinci Single-Site® platform. The value of robotic single-site cholecystectomy is still under debate. The aim of this study was to compare perioperative measures and postoperative outcomes of both robotic assisted approaches. 142 patients with benign gallbladder disease underwent da Vinci multiport (DVMPC; n = 111) or da Vinci Single-Site® cholecystectomy (DVSSC; n = 31) in our institution between October 2015–December 2018. Patient demographics and characteristics, perioperative measures, complications and outcomes were retrospectively analysed. Patients with DVSSC had a significant lower BMI an were younger compared to DVMPC patients (BMI: 25.2 versus 28.1, p = 0.004; age: 44.5 versus 54.2 years, p = 0.007). Operative time was longer in the DVSSC group (84.9 versus 69.9 minutes, p = 0.007). In the DVSSC group there were significantly more superficial surgical site infections (16.6 versus 3.6%, p = 0.024), more overall complications according to Clavien-Dindo (29.0 versus 9.9%, p = 0.016), and more pain on postoperative day 3 (numeric rating scale, 1.3 versus 0.4, p = 0.026). In both groups there were no injuries of hepatic hilar structures such as the common bile duct or of the right hepatic artery. DVSSC could be performed safely even in patients with acute cholecystitis and previous abdominal surgery. However, the da Vinci Single-Site® approach for cholecystectomy should not be considered as the standard of care procedure for benign gallbladder disease, due to a higher incidence of superficial surgical site infections, more overall complications and more postoperative pain compared to DVMPC.

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

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

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

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