Single-Site Robotic Cholecystectomy

Abstract

This study aims to introduce an alternative technique for effective single-site robotic cholecystectomy (SSRC) using a reverse port.Proper exposure of Calot's triangle is critical for safe laparoscopic cholecystectomy. Current robotic surgical systems are useful for single-site cholecystectomy. However, in exposing Calot's triangle, the gallbladder is usually retracted in a medial and upward direction, resulting in a narrow triangle. This intraoperative view is a major obstacle to safe laparoscopic cholecystectomy.From October 2013 to October 2014, 55 consecutive patients underwent SSRC by a single surgeon at Yonsei University Severance Hospital. Initially, 5 patients underwent the original robotic single site cholecystectomy technique, and the remaining 50 patients underwent robotic single site cholecystectomy using our reverse port technique.There were no differences between the SSRC-O (original port) group and the SSRC-R (reverse port) group in terms of patient age (P = 0.244), body mass index (P = 0.503), and pathologic conditions of the gallbladder (P = 0.841). Total operation time (132.6 vs 99.12 min; P = 0.009), actual dissection time (51.6 vs 30.28 min; P = 0.001), and console time (84.4 vs 50.46 min; P = 0.001) were all significantly shorter in the SSRC-R group. Mean intraoperative blood loss was minimal in both groups (20 vs 12.4 mL, P = 0.467), and bile spillage occurred in 2 patients of the SSRC-R group. There was one case of laparoscopic conversion in the SSRC-R group.The reverse port technique described in this study successfully widened Calot's triangle and improved the safety of the current robotic surgical system for single-site robotic cholecystectomy.

Initial experiences of robotic SP cholecystectomy: a comparative analysis with robotic Si single-site cholecystectomy

“…Among the limitations of RSSC is the loss of endo-wrist motion that is already being enjoyed in its multiport counterpart. Prior to the publication of reverse-port technique [7], traditional RSSC retracts the gallbladder fundus superomedially, which narrows the triangle of Calot. In RSPC, ideal superolateral retraction of the gallbladder fundus is accomplished by the third arm.…”

“…The advent of robotic single-site surgery (RSSS) platforms was very promising in addressing several limitations of SILS [5]. In the area of cholecystectomy, robotic single-site cholecystectomy (RSSC) paved the way for the preservation of ergonomic movement in single-site cholecystectomy [6,7]. Yet, some limitations, mainly the absence of endo-wrist motion limited the functionality of RSSS.…”

Technical feasibility of da Vinci SP single-port robotic cholecystectomy: a case report

“…In RSSC, the tract in the gel port provided for the assistant port is oriented supero-medially, hence retraction of the GB fundus follows the same direction, making the triangle of Calot narrower. Although this has been addressed by the reversed-port technique [10], resulting in the ideal supero-lateral retraction of the GB fundus, retraction remains unidirectional. The availability of the third arm in the SP system enables retraction in all directions as required by the different phases of the operation and as per the surgeon's preference.…”

Single-Port Laparoscopic and Robotic Cholecystectomy in Obesity (>25 kg/m2)

“…The fascia defect was closed with continuous absorbable suture and the skin was approximated with subcuticular continuous suture. 11…”