Anthony Y Teoh, FRCSEd, Gen, Enders K Ng, FRCSEd, Gen, Shannon M Chan, Hon C Yip, Vivien W Wong, Philip W Chiu. The Chinese University of Hong Kong
Background: Laparoendoscopic single-site surgery (LESS) allows the performance of surgery through a single wound. However, the LESS approach complicates surgery by limiting the dexterity of the laparoscopic instruments. The use of a robotic system equipped with the endo-wristÒ technology may significantly reduce the difficulty of LESS. Thus, the aim of the current study is to compare an endo-wristÒ equipped robotic LESS (R-LESS) cholecystectomy with 4-port laparoscopic cholecystectomy (LC) in a prospective comparative study.
Methods: This was an ongoing prospective comparative study conducted between September 2015 to September 2016 in one University and one Day surgery hospital. Consecutive patients that suffered from symptomatic gallbladder pathology indicated for cholecystectomy were included. They received either R-LESS cholecystectomy with the Da Vinci S system that is equipped with the endo-wristÒ technology using 5mm instruments or conventional LC. The primary outcome was the overall pain score. Secondary outcomes included activity pain scores, activity scores, patient satisfaction and comesis scores, analgesic requirements, conversion, morbidity rates and quality of life assessment scores.
Results: A total of 24 patients were recruited to the study (14 R-LESS vs 10 LC). There were no differences in background demographics. None of the procedures required conversion. There were no differences in mean (S.D.) operative time [62.3 (22.6) vs 72.1 (19.2) minutes, P = 0.274), hospital stay [1.4 (0.7) vs 1 (0) days, P = 0.104) and morbidity rates (14.3 vs 0%, P = 0.216). There was also no difference in the overall difficulty of the procedure [1.4 (1.5) vs 2.9 (2.5), P = 0.128) and the overall post-operative pain at days 1, 2, 3, 5, 7 and 4 weeks. There was a trend to more pain at D1 after standing for 5 minutes [5.4 (2.7) vs 2.8 (2.5), P = 0.053). No difference in satisfaction scores [6.6 (3.2) vs 8.8 (1.5), P = 0.107] was noted between the groups but worst cosmesis scores [5.8 (3.6) vs 8.8 (1.5), P = 0.045] were observed in the R-LESS group. No differences in quality of life assessments scores [22.9 (2.7) vs 24.4 (3.1), P = 0.371] were noted.
Conclusions: R-LESS and conventional laparoscopic cholecystectomy were comparable in perioperative outcomes. The use of the robotic approach with the endo-wristÒ function improves the ease of performing LESS cholecystectomy. The R-LESS approach was associated with slightly more pain and worst cosmetic appearance.
Figure 1. The R-LESS cholecystectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80713
Program Number: P689
Presentation Session: Poster (Non CME)
Presentation Type: Poster