Cholecystectomy using a novel Single-Site® robotic platform: early experience from 45 consecutive cases

Purpose: Continued efforts to reduce the invasiveness of conventional cholecystectomy techniques have resulted in the development of single-incision cholecystectomy. However, a single-port approach 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, objective evidence of the feasibility and ergonomics of single-incision robotic cholecystectomy (SIRC) is insufficient. Therefore, the present study aimed to evaluate the feasibility and efficacy of SIRC by using objective data obtained from consecutive patients who underwent surgery with the single-incision robotic platform performed by a single surgeon. Methods: Forty patients who underwent SIRC between August 2014 and December 2015 wereidentified. Demographic, perioperative, and postoperative data were collected retrospectively. Results:The mean docking time was 10.82±4.85 min (range, 4~30 min). The mean console time was 49.63±10.82 min (range, 24~90 min). None of the patients required an additional laparoscopic arm, an additional robotic arm, or conversion to conventional laparoscopic cholecystectomy. Conclusion:SIRC can provide a safe operative procedure, good operative results, and high patient satisfaction, and cause less surgeon fatigue. Therefore, our study results indicate that SIRC is feasible and favorable for both patients and physicians.

Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Single-incision Robotic Cholecystectomy: Initial Experience and Results

Cheng

Kim

Son

et al. 2017

“…[17][18][19] Additionally the stable, 3-D operation field can enhance a surgeon' s ergonomic environment. This enables surgeons to avoid the situation of right and left disorientation for triangular configuration during laparoscopic single-port surgery.…”

Section: Potential Technique: Robotic Single Site Plus One Port Distamentioning

confidence: 99%

Minimally Invasive (Laparoscopic or Robotic) Reduced Port (Single Port) Distal Pancreatectomy

Kang

2017

In spite of lack of randomized control study, laparoscopic distal pancreatectomy (DP) is regarded as appropriate treatment in managing benign and low grade malignant tumor in distal part of the pancreas. With the advance of laparoscopic skills, innovative instruments, and perioperative management, clinical effort to reduce the access injury for laparoscopic DP has been attempted to enhance the cosmetic effect and the benefit of minimally invasive surgery. Due to inborn technical limitation of laparoscopic surgical system, it is not easy to perform laparoscopic reduced port-or single port-distal pancreatectomy (LRP/LSP-DP) in daily routine clinical practice, however, surgical technique for safe and effective LRP/LSP-DP has been developed. Till now, only a few experts reported the technical feasibility and safety of LRP/LSP-DP in selected patients. According to literature review, the number of the patients who underwent LRP/LSP-DP seems to gradually increase. In this moment, surgical experiences may be too limited to reach the conclusion, but, with the help of robotic surgical system, LRP/LSP-DP has potential room for further investigation. Therefore, minimally invasive surgeons need to pay attention to this innovative movement. In this review, currently available surgical techniques for LRP/LSP-DP has been summarized with some future perspectives on this technique.

“…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.…”

mentioning

confidence: 99%

Single-incision Robotic Cholecystectomy: Initial Experience and Results

Kim

2017

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