Single incision cholecystectomy: Comparative study between Laparoscopic, Robotic and Spider Platforms.

Anthony M Gonzalez, MD, FACS, FASMBS, Juan-Carlos Verdeja, MD, FACS, Jorge R Rabaza, MD, FACS, FASMBS, Rupa Seetharamaiah, MD, FACS, Charan Donkor, MD, FACS, Rey Romero, MD, Radomir Kosanovic, MD, Francisco Perez-Loreto, MD, Jonathan Arad, MD

Baptist Health South Florida, Florida International University Herbert Wertheim College of Medicine

INTRODUCTION: The benefits of Single Incision Cholecystectomy (SIC) include better cosmetics, decreased parietal trauma and possible facilitation of postoperative recovery. Many series have shown the feasibility and safeness of Single Incision Laparoscopic Cholecystectomy (SILC), nevertheless this technique still has limitations, such as lack of triangulation, poor visualization, and instrument collision. Recently two different platforms, Robotic and SPIDER, attempt to ameliorate such problems. The purpose of this study is to compare three different techniques of SIC: Laparoscopic, Robotic and SPIDER, performed by a single surgical practice with three surgeons.

METHODS: We retrospectively collected, under IRB approval, data from our first 166 Single Incision Robotic Cholecystectomy (SIRC) and compared with the data of our first 166 SILC and last 166 Spider. All the SILC were performed with 3 trocars placed in one umbilical incision with the gallbladder retraction obtained with a prolene stitch; all the robotic cases were performed using the daVinci® Single Site Surgical System; and all the SPIDER procedures were performed using the SPIDER® Surgical System. There was major selection bias for SILC, no selection bias for SIRC and minor selection bias for SPIDER. Follow up was documented 30 days after surgery.

RESULTS: Each group (SILC, SIRC and SPIDER) included 128 (77.1%), 131 (78.9%) and 136 (81.9%) females. Mean age (years) was 45.3 (±13.6), 51.5 (±15.9) and 46.3 (± 15.1); Mean BMI (kg/m2) was 29.1 (±5.5), 29.4 (±6.1) and 27.4 (±4.8); and presence of previous abdominal surgeries were documented in 79 (47.6%), 60 (36.1%) and 86 (51.8%) for SILC, SIRC and SPIDER respectively. Mean Surgical Time (min) was 36.4 (range 17- 73), 63.1 (range 33-221) and 52.6 (range 24-121); and total hospital length of stay (days) was 1.3, 1.1 and 1.5 for SILC, SIRC and SPIDER respectively. Complications were seen in 3 (1.8%) SILC, 3 (1.8%) SIRC and 1 (0.6%) SPIDER and conversion to multiport 3 (1.8%) SIRC and 3 (1.8%) SPIDER.

CONCLUSIONS: Results of this study demonstrate similar results in most of the parameters measured among the three platforms. SILC appears to be superior in terms of surgical time compared to SIRC and Spider, nevertheless selection bias could be the influence. SILS, SIRC and SPIDER are all similar in terms of complication profile. It can be concluded that SILC, SIRC and SPIDER are all feasible and safe alternatives when used for SIC.

Session: Podium Presentation

Program Number: S081