A comparative study of outcomes between single-site robotic and multi-port laparoscopic cholecystectomy: An experience from a tertiary care center.

Banujan Balachandran, MS1, Taha Mustafa, MD1, Theadore A Hufford, MD1, Kunal Kochar, MD1, Leela M Prasad, MD1, Suela Sulo, PhD3, Joubin Khorsand, MD2. 1Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, 2General Surgery, Advocate Lutheran General Hospital, 3Russell Institute for Research & Innovation, Advocate Lutheran General Hospital

INTRODUCTION: To determine the safety and efficacy of single-site robotic cholecystectomy compared to multi-port laparoscopic cholecystectomy within a high-volume tertiary health care center.

METHODS AND PROCEDURES: A retrospective analysis of prospectively maintained data was conducted on patients undergoing single-site robotic cholecystectomy or multi-port laparoscopic cholecystectomy between October 2011 and July 2014. All surgeries included in the study were performed by a single surgeon. Pre-operative (i.e. age, gender), peri-operative (i.e. operative time, intra-operative complications, conversions), and post-operative (i.e. length of stay, immediate post-operative complications, delayed post-operative complications) data were collected from hospital and office medical records. Statistical analysis was performed using SPSS software, version 23.0 with Student's t test used to compare continuous data and Chi Square or Fisher’s Exact test for assessing categorical data. A p-value of 0.05 was considered statistically significant.

RESULTS: Within the established time frame, 415 (61%) single-site robotic cholecystectomies and 263 (39%) multi-port laparoscopic cholecystectomies were performed. Laparoscopic patients had a greater mean BMI (30.5 vs. 29.0 kg/m2; p=0.008) and were more likely to have undergone prior abdominal surgery (83.3 vs. 41.4%; p<0.001) than those in the robotic group. More patients with pre-existing co-morbidities (76.1% vs. 67.2%; p=0.014), including coronary artery disease (p=0.027) and COPD (p=0.049) were also found within the laparoscopic group. The average console time and docking time was 57 minutes and 6.8 minutes respectively, for all robotic procedures. No statistically significant differences were seen in the total operative time or the rate of conversions to open procedures between the two groups. The mean length of hospital stay post-procedure was shorter for patients within the single-site robotic group (1.9 vs. 2.4 days; p=0.012). However, in the short-term, patients who underwent single-site robotic procedures were diagnosed more frequently with wound infections (3.9% vs. 1.1%, p=0.037) and had more reported complaints of abdominal pain (8.4% vs. 4.2%; p=0.032). Furthermore, in the long-term, patients also developed incisional hernias much more frequently within the single-site robotic group than in the multi-port laparoscopic group (6.5% vs. 1.9%; p=0.006). No statistically significant differences were seen in the mean length of follow-up within the two groups of patients.

CONCLUSION: Single-site robotic cholecystectomy is a safe option for otherwise younger, more active patients without severe co-morbidities. Incisional hernias and wound infections are potential complications more likely to occur for patients undergoing single-site robotic cholecystectomy, as opposed to multi-port laparoscopic cholecystecomy and patients should be informed of these risks prior to their procedures.

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