First Results after Introduction of the Four-Armed da Vinci Surgical System in Fully Robotic Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy offers less post-operative pain, less complications, and faster recovery compared with open cholecystectomy. However, laparoscopic surgery can be demanding because of several technical drawbacks. Robotic surgery allows dexterity skills to be performed faster and shortens the learning curve, possibly leading to faster and safer laparoscopic surgery. Methods: In this paper, we report the results of our first 12 cases of fully robotic laparoscopic cholecystectomy using the da Vinci Surgical System, comparing them with 12 cases of conventional laparoscopic cholecystectomy. Using a fourth arm in robotic laparoscopy enables the surgeon to perform surgery without the use of a tableside assistant, leading to non-tiring, tremble-free assistance and reducing salary costs. Primary end points are operating time and costs. Secondary end points are operative complications and duration of admission. Results: Fully robotic cholecystectomy was completed in all 12 cases without increased complication rate and without conversions. However, robotic assistance results in an increased overall operating room stay of 31 min and increased costs of EUR 1,180.62. Conclusion: Fully robotic laparoscopic cholecystectomy is safe and feasible but seems more expensive and time consuming at this moment.

The Learning Curve of Robot-Assisted Laparoscopic Surgery

“…These important questions remain unanswered with the current data. Furthermore, the financial cost-benefit should also be considered (Heemskerk et al, 2005).…”

“…Four studies (Caratozollo et al, 2005, Vidovszky et al, 2006, Ruurda et al, 2002, Chitwood et al, 2001) showed a decrease of the robotic set-up time, but in only 2 studies this decrease was significant (Chitwood et al, 2001;Vidovszky et al, 2006). In one study robotic set-up time did not change in time (Heemskerk et al, 2005) and 2 studies did not report on the robotic set-up time (Perez et al, 2003, Giulianotti et al, 2003.…”

“…Four series were comparative studies (Perez et al, 2003;Guilianotti et al, 2003;Caratozollo et al, 2005;Heemskerk et al, 2005) and 3 series consisted of consecutive patient series www.intechopen.com (Chitwood et al, 2001;Ruurda et al, 2002;Vidovszky et al, 2006). In 6 studies the Da Vinci was used, in only one the Zeus-AESOP robotic system.…”

Computer-aided design/computer-aided manufacturing skull base drill

“…9 Subsequent applications in hip replacement and knee arthroplasty have demonstrated improved results with newer designs. 10,16,19 Applying the da Vinci robotic system, widely used in general surgery and urology, 8 has revealed that the device has limited application…”

Robotic surgery

“…138 For tubal anastomosis, the increase was $1,446. 87 For myomectomy, 93 pyeloplasty, 47 cholecystectomy 64,139 and Nissen fundiplication, 58,140 higher costs were also found for robot-assisted procedure. Most, if not all, cost-effectiveness analyses do not or only partly take into account indirect costs.…”