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

Gonzalez, Anthony; Murcia, Christian Hernandez; Romero, R.; Escobar, Ernesto; García, P. Rodríguez; Walker, Gail; Gallas, Michelle; Dickens, Eugene; McIntosh, Bruce; Norwood, William I.; Kim, Keith; Rabaza, Jorge; Parris, Don

doi:10.1007/s00464-015-4583-1

Cited by 30 publications

(18 citation statements)

References 36 publications

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“…In a prospective study of RC, in a broadly inclusive patient population, Vidovszky et al [24] demonstrated that no bile duct injury occurred even with a body mass index of 30.1 AE 7.1 kg/m 2 . Another multicenter study of initial experience with RC [25] reported a rate of 0.4% of postoperative bile leakage. In a case-matched control study, Breitenstein et al [6] concluded that robotic-assisted cholecystectomy is safe and a valuable approach.…”

Section: Discussionmentioning

confidence: 97%

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Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Wang

Lee

2017

The Kaohsiung J of Med Scie

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Conventional laparoscopic cholecystectomy (CLC) is currently the standard of surgical procedure for gallstone disease. Robotic cholecystectomy (RC) has revolutionized the field of minimally invasive surgery; it is safe and ergonomic, but expensive. The aim of this study is to compare the medical resource utilization and clinical outcomes between the two procedures. This study was conducted retrospectively by assessing data of the clinical outcomes and medical resource of 78 patients receiving RC and 367 patients receiving CLC. We reviewed the data of operation times, length of hospital stay, hospital charges, outpatient department visits, outpatient department service charges, and postoperative complications, which were retrieved from the health information system (HIS) database in this hospital. Patients in both groups had similar demographic and clinical features. The RC group had longer length of hospital stay (p=0.056), significantly longer operation time (p=0.035), and much more hospital charges (p=0.001). The RC group, however, experienced less postoperative complication rates (average 3.8% vs. 20.4%, p=0.001). Conversion rate was 1.9% in the CLC group versus 0% in the RC group (p=0.611). Most complications were mild, and following the Clavien-Dindo classification, there were two cases (2.5%) Grade I for the RC group; 50 cases (13.6%) Grade I and 14 cases (3.81%) Grade II for the CLC group (p<0.001 and 0.001, respectively). Procedure-related complications of Grade IIIa status were encountered in nine patients (2.45%) in the CLC group and none in the RC group (p=0.002).The RC group consumed more medical resources in the index hospitalization; however, they experienced significantly less postoperative complications.

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Section: Discussionmentioning

confidence: 97%

“…Another multicenter study of initial experience with RC demonstrated a high success rate in 465 cases; Gonzalez et al. [25] reported a rate of 0.4% of postoperative bile leakage. In a case‐matched control study, Breitenstein et al.…”

Section: Discussionmentioning

confidence: 98%

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Wang

Lee

2017

The Kaohsiung J of Med Scie

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“…9 However, that study was limited in that it did not include a comparative analysis for SIRC. In the present study, the operation time was 97.2 min, the console time was 49 min, and the docking time was 10 min, which is similar to other reports.…”

Section: Editorialmentioning

confidence: 99%

“…According to a previous report, there are limitations to this procedure, such as short-term follow up and selection bias. 9 Specifically, they found that the follow up period was too short to show the incisional hernia rate. Accordingly, additional studies investigating long-term outcomes are needed to establish the incisional hernia rate.…”

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confidence: 99%

“…8 A recent multicenter study showed a short operative time of RSSC of 52 min with a decreasing trend after 55~85 cases. 9 However, that study was limited in that it did not include a comparative analysis for SIRC. In the present study, the operation time was 97.2 min, the console time was 49 min, and the docking time was 10 min, which is similar to other reports.…”

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confidence: 99%

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Single-incision Robotic Cholecystectomy: Initial Experience and Results

Kim

2017

J Minim Invasive Surg

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EDITORIALAlthough there have been many studies of the safety or feasibility of single-incision laparoscopic surgery (SILS) since it was first performed in 1997, 1 most surgeons agree that it has disadvantages such as difficulty conducting triangulation, instrument crowding, and collisions. [2][3][4] To overcome these limitations of laparoscopy, the robotic platform was developed, providing advantages including three-dimensional view, magnification, and an articulated instrument.5 However, robotic surgery requires a longer set-up time and operation time than laparoscopy.6 For single-incision robotic cholecystectomy (SIRC), there are debates regarding operation time, with some authors reporting a longer operation time for SIRC than SILS (98 vs 68 min, p<0.001).7 Conversely, a significant difference in operation time was reported for RSSC (62 min) and SILS (83 min).8 A recent multicenter study showed a short operative time of RSSC of 52 min with a decreasing trend after 55~85 cases. 9 However, that study was limited in that it did not include a comparative analysis for SIRC. In the present study, the operation time was 97.2 min, the console time was 49 min, and the docking time was 10 min, which is similar to other reports.7,10 The authors also described a decreasing trend of console time with accumulation of experience, indicating the potential to overcome the long operation time of SIRC.The first single-incision robotic cholecystectomy (SIRC) was successfully performed in humans in 2010, 11 and the safety and feasibility of SIRC have since been published in many reports. Moreover, there have been no severe complications, such as injury to the bile duct or conversion to laparoscopy or open surgery, 11,12 although one case of postoperative hemorrhage associated with SIRC has been reported. 13 Additionally, some authors have investigated cosmetic outcome and postoperative pain in comparative studies, 14,15 with less pain and better cosmetic outcomes occurring in SILC. 16,17 The results of the present study also showed good outcomes without any conversions or complications, even when no additional port was used during the procedure. In another recent study, the authors reported their experience of SIRC in a broadly inclusive patient population with six conversions to laparoscopy, one to open surgery, and one aborted case.18 Here, we focus on indications of SIRC. The surgical outcome in earlier studies was excellent because the initial inclusion criteria in most studies were limited in symptomatic gallstones or gallbladder polyps, and did not include high BMI or acute cholecystitis. 6,8 To clarify the effectiveness of SIRC, operative indications should be extended in all cases of gallbladder diseases. However, gallbladder retraction is not easy in cases of edematous or dense Corresponding author

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

Lim

Nassif

Lahat

et al. 2017

Robotics Computer Surgery

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

Abstract: Our large, multicenter study demonstrates that robotic single-site cholecystectomy is safe and feasible in a wide range of patients.

Cited by 30 publications

References 36 publications

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Single-incision Robotic Cholecystectomy: Initial Experience and Results

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

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