Robotic Single-Incision Cholecystectomy, Although a Feasible and Safe Option, Dramatically Increases Operative Time When Compared to Single-Incision Laparoscopic Cholecystectomy

Maureen D Moore, MD, Jonathan Abelson, MD, Renee Tholey, MD, Suraj Panjwani, MBBS, Rasa Zarnegar, MD, Cheguevara Afaneh, MD. New York Presbyterian Hospital-Weill Cornell Medical Center

INTRODUCTION: Surgeon-specific outcomes data has compared standard laparoscopic versus single-incision laparoscopic cholecystectomies. The purpose of our study was to compare perioperative outcomes between single-incision laparoscopic cholecystectomies (SILC) and robotic single-incision cholecystectomies (RSILC) in patients with biliary disease.

METHODS: We retrospectively reviewed 50 consecutive patients who underwent a SILC or RSILC for acute cholecystitis, biliary colic/symptomatic cholelithiasis, gallstone pancreatitis and gallbladder polyps. We compared the first 21 patients undergoing RSILC to the first 29 patient undergoing SILC from January 2010 to September 2015. A total of two surgeons experienced in robotic surgery participated in the study. Preoperative variables included demographics, body mass index (BMI), ASA score, and abdominal surgical history. Surgical variables included number of ports, total operative time, estimated blood loss (EBL), conversion data, morbidity and length of stay (LOS). Our primary end-point was operative time. Our secondary end-points were morbidity and LOS.

RESULTS: Preoperative parameters were not significantly different between the two groups except for age (Table 1). Mean operative time was 51% longer in RSILC when compared to SILC (120±32 mins versus 79±35 mins, p≤0.0001). There were no significant differences in EBL, conversion rates, intraoperative, and post-operative complication rates. There was one complication in the RSILC group and two occurred in the SILC group. One patient in each group developed choledocholithiasis requiring re-admission and ERCP. The other complication was a surgical site infection, which was treated with antibiotics. The rate of additional port placement was not significantly different. Furthermore, LOS was not statistically significant (Table 2). There was a strong inverse correlation between chronologic case number and operative time for SILC, (r2=0.15; P=0.04) however not for RSILC (P=0.19). There was no difference in surgeon-specific operative times.

CONCLUSION: RSILC is both safe and feasible. However, given the significant difference in operative time compared to SILC, the robotic platform may not be cost-effective for surgeons that can adopt single-incision laparoscopic surgery. If unfamiliar with single-incision laparoscopic surgery, the robotic platform offers an additional tool in the surgeon’s armamentarium. 

Figure 1: The learning curves for robotic single incision cholecystectomy and single incision laparoscopic cholecystectomy

Figure 1: The learning curves for robotic single incision cholecystectomy and single-incision laparoscopic cholecystectomy 

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