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

Hagen, Monika; Balaphas, Alexandre; Podetta, Michele; Rohner, Peter; Jung, Minoa; Buchs, Nicolas; Buehler, Leo Hans; Mendoza, Jona M; Morel, Philippe

doi:10.1007/s00464-017-5843-z

Cited by 24 publications

(36 citation statements)

References 20 publications

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“…A recent study by Hagen et al in 2018 showed similar early post-operative clinical results when comparing robotic single-site cholecystectomy versus multiport LC but found a higher rate of re-operations and higher perioperative and long-term costs with robotic single-site cholecystectomy [13]. A meta-analysis comparing robotic with traditional minimally invasive surgery completed in 2016 showed a decrease in blood loss and transfusion rates.…”

Section: Discussionmentioning

confidence: 97%

Robotic versus Laparoscopic Cholecystectomy: Case-Control Outcome Analysis and Surgical Resident Training Implications

Ghanem

Shaheen

Blebea

et al. 2020

Cureus

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Section: Discussionmentioning

confidence: 97%

Robotic versus Laparoscopic Cholecystectomy: Case-Control Outcome Analysis and Surgical Resident Training Implications

Ghanem

Shaheen

Blebea

et al. 2020

Cureus

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“…In addition to reviewing the outcomes, we compared operative time, console time, EBL, and any significant intraoperative events and matched these based on patient age and gender. Choice of an SIRC vs MIRC approach was determined by surgeon preference, but SIRC compared to laparoscopic approach is generally favored for patients of lower BMIs [2].…”

Section: Discussionmentioning

confidence: 99%

“…Symptomatic cholelithiasis was the primary indicator for 50.5% of MIRC and only 36.4% of SIRC. It is assumed that SIRC patients are not in acute distress and have time for the cosmetically superior SIRC approach, as supported by 36.4% of the SIRC patients having stable dyskinesia vs only 23.8% or MIRC [2]. Intraoperative events did not vary among the two approaches and only irrigation usage was significant only marginally, which is most likely due to surgeon preference.…”

Section: Discussionmentioning

confidence: 99%

“…The da Vinci system (Intuitive Surgical, Inc., Sunnyvale, CA) has been used to perform cholecystectomies since 1997, and single-incision robotic cholecystectomy (SIRC) was introduced in 2011 to overcome the previous limitations from a multi-incision robotic cholecystectomy (MIRC) [1-2]. SIRC has been favored in cholecystectomies because of the minimal scarring visible by hiding the entry point in the umbilicus and reduction in postoperative pain [3].…”

Section: Introductionmentioning

confidence: 99%

“…As an alternative to MIRC, SIRC has foreseeable benefits, but the real clinical benefits for patients remain a matter of debate. The primary pitfalls of SIRC have been associated with incisional/trocar site hernias and visceral injuries related to the larger midline incision [2,4]. SIRC has improved cosmetic appearance although the intraoperative difficulty is higher compared to MIRC, which may not offset the benefit especially in pediatrics [5].…”

Section: Introductionmentioning

confidence: 99%

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

Schertz¹,

Misra²,

Livert

et al. 2019

Cureus

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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.

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Does single‐site robotic surgery makes sense for gallbladder surgery?

Bosi

Rombaldi

Zaniratti

et al. 2022

Robotics Computer Surgery

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Background Cholecystectomy is one of the most performed surgeries. Several techniques were created, generating less pain, better aesthetic results and faster return to activities. Robotic surgery through a single portal combined the advantages of single‐incision surgery with the principles of conventional laparoscopy, making it a safe and feasible procedure. However, due to the high costs, this technology is hardly available in practice, especially in the public health system. The objective is to evaluate the safety of robotic cholecystectomy using the da Vinci Single‐Site © Surgical Platform (DVSSP) in a tertiary public hospital, and to assess alternatives that can reduce the costs, influencing the final real value of the procedure. Methods Prospective and descriptive study evaluating robotic cholecystectomies using the DVSSP technology performed at Hospital de Clínicas de Porto Alegre from May 2017 to November 2018. Results A total of 37 cholecystectomies were performed. The average time of surgery was 82.62 min, and no intraoperative complications were observed. There was a need for conversion to conventional laparoscopy in two surgeries (5.4%). The average cost of the robotic procedure was U$ 1146.23 and the amount passed on to the institution by the Brazilian Unified Health System was on average U$ 212.59 (p < 0.05). Postoperative outcomes were satisfactory, with an incisional hernia index of 8.1%. Conclusion Although robotic surgery in this setting is a safe and feasible alternative, the high cost of the procedure prevents its dissemination on a large scale. New alternatives are needed to reduce the value and to allow greater accessibility.

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

Cited by 24 publications

References 20 publications

Robotic versus Laparoscopic Cholecystectomy: Case-Control Outcome Analysis and Surgical Resident Training Implications

Robotic versus Laparoscopic Cholecystectomy: Case-Control Outcome Analysis and Surgical Resident Training Implications

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

Does single‐site robotic surgery makes sense for gallbladder surgery?

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