Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Abstract

Robotic-associated minimally invasive surgery is a novel method for overcoming some limitations of laparoscopic surgery. This study aimed to evaluate the outcomes (postoperative pain, cosmesis, surgeon's workload) of single-incision robotic cholecystectomy (SIRC) vs. single-incision laparoscopic cholecystectomy (SILC) vs. conventional three-port laparoscopic cholecystectomy (3PLC). Methods: 134 patients who underwent laparoscopic or robotic cholecystectomy at a single center during 2016~2017 were enrolled. Prospectively collected data included demographics, operative outcomes, questionnaire regarding pain and cosmesis, and NASA-Task Load Index (NASA-TLX) scores for surgeon's workload. Results: 55 patients underwent SIRC, 29 SILC, and 50 3PLC during the same period. 3PLC patient group was older than the others (SIRC vs. SILC vs. 3PLC: 48.1 vs. 42.2 vs. 54.1 years, p<0.001). Operative time was shortest with 3PLC (44.1 vs. 38.8 vs. 25.4 min, p<0.001). Estimated blood loss, postoperative complications, and postoperative stay were similar among the groups. Pain control was lowest in the 3PLC group (98.2% vs. 100% vs. 84.0%, p=0.004), however, at 2 weeks postoperatively there were no differences among the groups (p=0.374). Cosmesis scores were also worst after 3PLC (17.5 vs. 18.4 vs. 13.3, p<0.001). NASA-TLX score was highest in the SILC group (21.9 vs. 44.3 vs. 25.2, p<0.001). Conclusion: Although SIRC and SILC take longer than 3PLC, they produce superior cosmetic outcomes. Compared with SILC, SIRC is more ergonomic, lowering the surgeon's workload. Despite of higher cost, SIRC could be an alternative for treating gallbladder disease in selected patients.

A retrospective multicentre study on the evaluation of perioperative outcomes of single‐port robotic cholecystectomy comparing the Xi and SP versions of the da Vinci robotic surgical system

“…2,[16][17][18][19][20] The advent of robotic platform combined with single-site skill for laparoscopic surgery is getting great attention from surgeons because of its improvement in cosmesis and reduction of surgeon's stress load. 4,8 In a previous study in our centre, early experience of SIRC with Xi was demonstrated with a rapid learning curve and no major complications such as common bile duct injury or gallbladder perforation. 10 Moreover, in another study, three-port laparoscopic cholecystectomy (3PLC), SILC, and SIRC were compared, showing good cosmetic outcome and low workload with similar postoperative outcomes in SIRC.…”

“…Technology in surgery has continued to evolve and is now more advanced than ever 2,16–20 . The advent of robotic platform combined with single‐site skill for laparoscopic surgery is getting great attention from surgeons because of its improvement in cosmesis and reduction of surgeon's stress load 4,8 . In a previous study in our centre, early experience of SIRC with Xi was demonstrated with a rapid learning curve and no major complications such as common bile duct injury or gallbladder perforation 10 .…”

“…10 Moreover, in another study, three-port laparoscopic cholecystectomy (3PLC), SILC, and SIRC were compared, showing good cosmetic outcome and low workload with similar postoperative outcomes in SIRC. 4 Recently, SP, the most recent model of robotic surgical platforms, has been applied for minimally invasive surgery in various surgical fields. Its main feature is having a single arm that needs to be docked only once, making the docking process much simpler than the previous multi-arm platform.…”

“…With the increasing demand for minimally invasive surgery, laparoscopic cholecystectomy (LC) has become the gold standard in patients with benign gallbladder disease indicated for surgery 1–3 . Single‐incision laparoscopic cholecystectomy (SILC), which is performed using a single‐port technique through only one incision in the periumbilical area, has been developed for better cosmetic outcomes and minimization of surgical wound 2,4–7 …”

Learning curve of surgical novices using the single-port platform SymphonX: minimizing OR trauma to only one 15-mm incision

“…Surgeons using a single-port system for cholecystectomy reached the lowest NASA-TLX scores in comparison to surgeons performing a laparoscopic cholecystectomy using three-port laparoscopic technique and surgeons performing a single-incision robotic cholecystectomy. Enumerated reasons were partly missing overview of anatomical structures, crossed instruments, and the single-port causing fatigue of surgeons through gas leakage [41]. This is relevant as an increased workload was associated with a poorer surgical performance [40].…”