Jae Hoon Lee, Ki Byung Song, Dae Wook Hwang, Song Cheol Kim, Kwang-Min Park, Young-Joo Lee. Asan Medical Center, Seoul, Korea
Minimally invasive approaches for cholecystectomy are evolving in a surge for the best possible clinical outcome for the patients. A robotic set of instrumentation to be used with the da Vinci Si Surgical System has been developed to overcome some of the technical challenges of manual single incision laparoscopy.
From August 2014 to March 2015, all consecutive robotic single-site cholecystectomies (RSSC) were prospectively collected in a dedicated database. Demographic, intra- and postoperative data of all patients that underwent RSSC at Asan Medical Center (Seoul, Korea) were analyzed.
During 12 months, 120 patients (83 women, 37 men) underwent RSSC at our institution. The operations were performed by 5 experienced hepatobiliary surgeons. The dominating preoperative diagnosis was cholelithiasis. Average patient’s age was 42.1 years (range, 17-64), and average body mass index was 23.8 kg/m2 (range, 17-37). The mean robot docking time was 5.8 ± 2.4 min (range, 3-20), and surgeon console time was 18.4 ± 12.2 min (range, 5-65). The mean overall operative time (skin-to-skin) was 48.8 ± 16.7 min (range, 25-105). Completion of RSSC was done in 119 patients. One patient with conversion to conventional laparoscopy due to severe inflammation with dense adhesion was observed, and final diagnosis of this patient was xanthogranulomatous cholecystitis. Except one case of laparoscopic conversion, no cases required traction suture, additional robotic arm, conversion to open or drain. Intraoperative blood loss was negligible. There were no collisions between the robotic arms and no other robot-related problems. Average postoperative length of stay was 1.7 day (range 1-4). There were no immediate postoperative complications (bleeding, bile leak, strictures, or wound dehiscence). The mean Numerical Rating Scale score 6 hours after the operation was 2.9 ± 1.2 (range, 1-7). After discharge, two patients had a superficial wound infection that was treated with a course of dressing, and resolved without any further consequence. In follow-up of all patients, there were no biliary leaks, no bile duct or hepatic artery injury, and other inadvertent injuries to the surrounding structures.
RSSC is feasible and safe and requires a minimal learning curve to transition from traditional multiport to single-port robotic cholecystectomy.