Jae Hoon Lee, Ki Byoung Song, MD, Sang Hyung Shin, Song Cheol Kim, Young Joo Lee, Kwang Min Park. Asan Medical Center
Single-site laparoscopic cholecystectomy (SSLC) still has some difficulties, such as clashing of instruments and loss of triangulation. So, this has not been widely used. Single-site surgery with the robotic platform (da Vinci Si, Intuitive Surgical Inc.) was introduced to enable the surgeon to perform the precise and comfortable movement. This system provides fine visualization and avoids instruments collisions. The purpose was to evaluate feasibility and efficacy of robotic single-site cholecystectomy (RSSC) compared to SSLC. The medical records of patients who received RSSC, from Aug 2014 to July 2017, were reviewed retrospectively comparing to SILC, from Jan 2013 to March 2015. All surgeries were consecutively performed by two experienced surgeon.
The mean age in the RSSC group (n=520) was 48.0 ± 10.1 years, and BMI was 23.9 ± 3.6. SSLC group (n=110) was 36.4 ± 9.6 year and BMI 21.8 ± 2.4. The proportion of patients with high BMI(>25) was high in RSSC group (p < 0.001). There was female (RSSC 74.1%, SSLC 92.7%) and cholelithiasis (RSSC 72.2%, SSLC 67.4%) dominant with proportion and Indications for surgery. Total operation time of RSSC was 46.9 ± 12.1 minutes, and significantly shorter than was 53.4 ± 16.6 minutes for SSLC. For RSSC, mean docking time from incision to completion of docking procedure was 7.1 min (range 5-20), and console time was 17.8 min (range 5-65). In both group, there was no any case with requiring open conversion. In RSSC, 3 cases were converted laparoscopic 4-ports procedure. Reason for conversion was inability to visualization of vascular structure and to traction gallbladder because of severe inflammation. In SSLC, 3 cases converted to 3-ports laparoscopic procedure and 5 cases required one additional port. The length of stay was shorter in RSSC group (RSSC 3.3 ± 1.7, SSLC 4.0 ± 1.8) There was no significant difference in the postoperative pain score. In both group, there was no critical complications including hepatic artery injury or bile duct injury. Intraoperative bile spillage was occurred 7.4% in SSLC, 5.4% in RSSC. Wound complications were less than 2% in both groups. Incisional hernia occurred one case in each group.
RSSC is safe and feasible procedures. With accumulating of experience, RSSC had more short operative time than SSLC. Comparing to SSLC, RSSC is relatively suitable to acute gallbladder disease and high BMI and requires a minimal learning curve to transition from traditional multiport to single-port robotic cholecystectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87663
Program Number: P804
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster