Robotic assisted cholecystectomy – A retrospective cohort study of experience of 106 first robotic cholecystectomies in versius robotic platform

Abstract

Introduction Laparoscopic cholecystectomy is currently the standard of care for symptomatic cholelithiasis as well as for chronic and acute cholecystitis. The incidence of bile duct injury in laparoscopic cholecystectomy is still higher than that in open surgery. Surgical robots aim to bridge this gap. With the greater availability of surgical robots and cheaper alternatives to the Da Vinci system, surgeons can take advantage of the better manoeuvrability and better vision that a surgical robot offers. This is likely to make robotic assisted cholecystectomy a very safe option. Here, we present our early data on the robotic procedures performed by the Versius robotic system by CMR (Cambridge Medical Robotics). Methods It is a retrospective study, with data collected from our prospectively maintained database at Swagat Super Speciality Surgical Institute and NH, maintained collectively by CMR and our surgical residents. The first consecutive 106 planned robotic cholecystectomies that were performed by a single surgeon were included in the study. Results Out of 106 serial planned robotic assisted cholecystectomies (101 robotic assisted cholecystectomies + 5 combined with other procedures), no bile duct injury was reported, with a mean console time of 54.16 min and a mean setup time of 9.29 min. One procedure had to be converted to open for malignancy, and another patient had to be converted to laparoscopy due to dense adhesions with the duodenum. Three chronic liver disease (CLD) patients underwent partial cholecystectomy. A total of 70.75% of patients had no pain – visual analogy scale (VAS) pain score of 0 at POD 1 with minimal blood loss in most of the procedures. No learning curve for robotic assisted cholecystectomy was seen. Conclusion Although robotic assisted cholecystectomy was mostly chosen for patients in whom difficult cholecystectomy was clinically anticipated, it fared quite well. The learning curve was essentially non-existent. Robotic assisted cholecystectomy is a safe and feasible option in both simple and difficult cases of gallbladder disease. Highlights

New Robotic Platforms in General Surgery: What’s the Current Clinical Scenario?

“…The reported cases belonged to several specialties: hepatopancreatobiliary surgery [13,[37][38][39][50][51][52][53][54][55]78,79,[87][88][89][90][91][92][93][94][95][96][97][100][101][102][103] (Tables S1 and S2), colorectal surgery [14-36,56- The authors belonged to institutions located in: South Korea (n = 27), China (n = 16), North America (n = 13), Lithuania (n = 11), Japan (n = 8), Germany (n = 6), Italy (n = 6), United Kingdom (n = 6), India (n = 4), United Arab Emirates (n = 2), Taiwan (n = 1), France (n = 1), Croatia (n = 1), Australia (n = 1).…”

“…Among the included studies, 36 were case reports [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], 52 were noncomparative studies [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ,…”

“…The reported cases belonged to several specialties: hepatopancreatobiliary surgery [ 13 , 37 , 38 , 39 , 50 , 51 , 52 , 53 , 54 , 55 , 78 , 79 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 100 , 101 , 102 , 103 ] ( Tables S1 and S2 ), colorectal surgery [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 56 , 57 , 58 , 59 , ...…”

“…Thirteen articles reported on emergency cases performed via a robotic approach. Two incarcerated hernias [ 12 , 88 ], one perforated gastric ulcer [ 96 ], seven acute appendicitis [ 91 , 96 ], and 99 acute cholecystitis [ 50 , 51 , 52 , 54 , 87 , 88 , 97 , 100 ] were described.…”

“…Forty-five (43.7%) authors reported the surgical background of the operating surgeon and his previous experience [26,31,33,45,[47][48][49][50][51][52][53][54][55][56][57][58][59]62,64,67,69,76,77,79,[83][84][85][86][87][88][89][90][91][92]94,96,99,[102][103][104][105][106][108][109][110]. A structured training process of the surgical team on the adopted system was reported by 28 (27.2%) authors [26,40,[47][48][49]…”