Hien Le, MD, Greg Mancini, Matt Mancini. University of Tennessee Medical Center
The application of robotic surgery in the treatment of gallbladder disease has been considered controversial due to cost-utilization concerns. However, when looking at patients with elevated risk for complications, specifically the obese population, the application of robotics may serve beneficial. We therefore hypothesize that robotic cholecystectomy with intraoperative cholangiogram in morbidly obese patients may reduce risk and operative times, potentially justifying its use in this population.
Methods and Procedures
This was a single institution retrospective review of robotic assisted cholecystectomies performed by two surgeons at our institute. General surgery robotics began in 2012. The cohort of patients who had robotic cholecystectomy from 2012 to June 2014 was obtained and reviewed for operative data and outcomes. Intraoperative cholangiogram was either attempted or successfully performed for all the patients in the study. Operative results were compared to published results in the literature.
There were 66 robotic cholecystectomies performed during the designated time. The mean time to perform the procedures for all patients was 81 minutes. For patients with BMI 35 or greater, the mean time was 85 minutes. With regard to learning curve, the first 15 cases for both surgeons averaged 90 minutes, with subsequent cases averaging 74 minutes. When only looking at patients with BMI 35 or greater, the first 15 cases averaged 93 minutes, with subsequent cases averaging 76 minutes. There were no cases converted to open, one converted to conventional laparoscopy and one in which IOC was unable to be completed. There were no bile duct injuries. Complications included prolonged operative time due to difficult dissection from liver disease (n=1), bowel injury due to adhesions (1), reintubation due to hypercarbic respiratory distress (n=1), and colitis (n=1).
We were able to perform robotic cholecystectomy with intraoperative cholangiogram in morbidly obese patients, with similar operative efficiency as compared to published times of conventional laparoscopy and a low complication rate. The learning curve is short, between 12-15 cases, regardless of BMI. Therefore, in the obese population with elevated risks, robotic cholecystectomy may be justified.