A Comparison of Robotic Single Incision and Traditional Single Incision Laparoscopic Cholecystectomy

Tariq Lescouflair, MD, Monica Gustafson, MD, Ibrahim Daoud, MD, FACS. Department of Minimally Invasive Surgery, St. Francis Hospital and Medical Center; Hartford, CT.

Introduction: Once laparoscopy proved to be a safe and reliable method of performing many abdominal surgical procedures, surgeons have continued to advanced technology and develop less invasive methods for performing common surgical procedures. This trend ultimately led to the invention of robotic surgery, which began in ernest in the 1990s. In recent years, robotic surgery has gained popularity, with many urologic, gynecologic and general surgical procedures exploring its many advantages. The aim of this project is to evaluate the utility of robotics in the context of single incision laparoscopic cholecystectomy (SILC).

Methods: A retrospective review of a prospectively maintained database of both robotic single incision laparoscopic cholecystectomy (RSILC) and traditional SILC was performed. The database includes all consecutive RSILC and SILC performed by a single surgeon at our institution from August 2010 to the present date. All consecutive RSILC patients were matched with patients of similar age, gender, ASA, and BMI undergoing SILC. Outcomes and cost were compared between the two groups. Primary outcomes include rate of conversion, defined by the use of any additional ports and operative time. Secondary outcomes include duration of narcotic use, time to independent performance of daily activities and cost. Categorical variables were evaluated using chi square analysis and continuous variables using t-test.
Results: 41 patients undergoing RSILC and 41 patients undergoing SILC included in the analysis. Demographics, including age, gender, ASA and BMI were similar. There was no difference in conversion rate between RSILC and SILC (9 vs 11%, p = 0.60). Mean operative time for RSILC was significantly greater compared to SILC (96.7 vs 65.2 min, p = 4.8×10^-6). RSILC was associated with a slightly longer duration of narcotic use (1.6 vs 2.4 days, p = 0.0068) and time to independent performance of daily activities (2.3 vs 4 days, p = 8.5×10^-6). Cost is higher but does not seem to be significantly so in RSILC ($3673 vs $7518, p = 0.056)

Discussion: Conversion rates are similar in RSILC and SILC suggesting that technical difficulty is comparable. Narcotic use and time to restoration of independent activity seem to be slightly higher in the RSILC group. The mean cost was higher in the RSILC group, however this did not seem to be a statistically significant difference. This may be due in part to specialized equipment required for the robotic platform as well as increased operative time.