Telerobotic Laparoscopic Cholecystectomy: Initial Clinical Experience With 25 Patients

Abstract

ObjectiveTo determine the safety and feasibility of performing telerobotic laparoscopic cholecystectomies. This will serve as a preliminary step toward the integration of computer-rendered three-dimensional preoperative imaging studies of anatomy and pathology onto the patient's own anatomy during surgery. Summary Background DataComputer-assisted surgery (CAS) increases the surgeon's dexterity and precision during minimally invasive surgery, especially when using microinstruments. Clinical trials have shown the improved microsurgical precision afforded by CAS in the minimally invasive setting in cardiac and gynecologic surgery. Future applications would allow integration of preoperative data and augmented-reality simulation onto the actual procedure. MethodsBeginning in September 1999, CAS was used to perform cholecystectomies on 25 patients at a single medical center in this nonrandomized, prospective study. The operations were performed by one of two surgeons who had previous laboratory experience using the computer interface. The entire dissection was performed by the surgeon, who remained at a distance from the patient but in the same operating room. The operation was evaluated according to time of dissection, time of assembly/disassembly of robot, complications, immediate postoperative course, and short-term follow-up. ResultsTwenty of the 25 patients had symptomatic cholelithiasis, 1 had a gallbladder polyp, and 4 had acute cholecystitis. Twenty-four of the 25 laparoscopic cholecystectomies were successfully completed by CAS. There was one conversion to conventional laparoscopic cholecystectomy. Set-up and takedown of the robotic arms took a median of 18 minutes. The median operative time for dissection and the overall operative time were 25 and 108 minutes, respectively. There were no intraoperative complications. There was one postoperative complication of a suspected pulmonary embolus, which was treated with anticoagulation. All patients were tolerating diet at discharge. ConclusionsLaparoscopic cholecystectomy performed by CAS is safe and feasible, with operative times and patient recovery similar to those of conventional laparoscopy. At present, CAS cholecystectomy offers no obvious advantages to patients, but the potential advantages of CAS lie in its ability to convert the surgical act into digitized data. This digitized format can then interface with other forms of digitized data, such as pre-or intraoperative imaging studies, or be transmitted over a distance. This has the potential to revolutionize the way surgery is performed.Computers and technology are increasingly interacting with surgeons both inside and outside of the operating room, as exemplified by the rapid adoption of laparoscopy into routine use. The computer's ability to enhance, modify, or transform electronic data is changing patient management before, during, and after surgery. As such, these technologic advancements are having an ever-increasing influence on the way surgery is planned and performed.

Laparoscopic Treatment for Esophageal Achalasia and Gastro-Esophago-reflex Disease Using Radius Surgical System

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An Ergonomic and Human Factors Comparison Between Manual and Telerobotic Simulated Endoscopic Surgery

“…These include: increased three-dimensional accuracy, increased precision of movements, reproducibility of repeated procedures, and the ability to perform surgery from a distance [3,5]. Technological advancements and an increased demand for telerobotic surgery systems may soon result in decreased cost.…”

Robotik Gastrointestinal Cerrahide Güncel Uygulama

“…Comparative studies did not demonstrate any significant difference between the two procedures in terms of complications, hospitalization period and conversion to open, while RAL cholecystectomy tended to be more expensive than the latter (8). RAL cholecystectomy with da Vinci in daily routine does not seem to be practical for at least the next few years due to its longer preparation and operative time compared to conventional laparoscopic cholecystectomy (9 (11,12). Overall experience suggested that cholecystectomy can be performed comfortably and safely via RAL.…”