The emerging role for robotics in cholecystectomy: the dawn of a new era?

Abstract

Though laparoscopic cholecystectomy (LC) was highly criticized in its early stages, it quickly grew to become a new standard of care and has revolutionized the field of general surgery. Now emerging robotic technology is making its way into the minimally invasive arena. Robotic cholecystectomy (RC) is often disparaged as a costly technology that can lead to increased operative times with outcomes that are quite similar to LC. However, this perspective is skewed as many existing studies were performed in the early phase of learning for this procedure. RC can be performed in a cost-effective manner as the volume of robotic procedures increases. In addition, improved visualization and capability to perform fluorescence cholangiography can improve the safety profile of cholecystectomy to a level that has not yet been achieved with conventional laparoscopy. Advanced simulation technology for robotic surgery, and newer singlesite robotic platforms have the potential to further revolutionize this technology and lead to improved patient satisfaction. In this review, we will present current data, trends, and controversies in robotic-assisted cholecystectomy.

A Potential Role for Robotic Cholecystectomy in Patients with Advanced Liver Disease: Analysis of the NSQIP Database

“…The role for RC in cirrhotic patients is not well defined, as evident by the paucity of the literature on this topic. [9][10][11] However, a recent publication from Strosberg et al 12 demonstrated that RC had significantly lower rates of conversion to an open procedure, which is in alignment with the data presented in the present study. They also concluded that RC seemed to be a safe and feasible procedure, although more costly in comparison with LC.…”

“…This is well documented in the literature. [7][8][9]11 Similarly, Dolejs et al 5 demonstrated that patients undergoing OC had higher rates of mortality and morbidity across all MELD scores than those undergoing LC. It is likely that this is amplified in patients with higher MELDs, and thus explains the higher rate of postoperative complications observed in these patients in our study.…”

“…16 There are studies that have shown MELD score to be a better predictor of outcomes in these patients than Child-Pugh scores. 9…”

“…RC has not gained widespread acceptance in part because of the potential for increased operative time and higher cost, with no clear advantage over LC in terms of clinical outcomes. 9 Given the potential advantages of a robotic approach to cholecystectomy, the aim of this study was to study the outcomes of RC in patients with advanced liver disease.…”

Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting: A prospective randomised double-blind controlled trial

“…Advanced simulation technology for robotic surgery and new single-site robotic platforms have the potential to further revolutionise this technology and lead to a better patient satisfaction. [ 24 ] Robotic single-port cholecystectomy is feasible but hindered by technical challenges due to the inadequate length of non-wristed robotic instruments as well as cost. On the other hand, high incidence of gallbladder rupture and trocar-site hernias may limit its application.…”