Single Incision Cholecystectomy Utilizing Spider Surgical System: Case Series of 40 Patients

Shyam L Dahiya, MD. Tri-City Regional Medical Center, Hawaiian Gardens, CA

Introduction: Single incision laparoscopic surgery has garnered wide interest in a number of specialties. A common limitation cited for many single incision methods is the lack of instrument triangulation and the need to cross instruments. The SPIDER® Surgical System (TransEnterix, Durham, NC) is a technology for single incision surgery that provides instrument triangulation and eliminates instrument crossing. This is a report of a single surgeon case series of 40 laparoscopic, single incision cholecystectomies utilizing the SPIDER® Surgical system to assess feasibility and safety.

Methods and Procedures: A Hasson cut down method is used to gain access to the peritoneal cavity, and the SPIDER device is inserted into the umbilicus under visualization. Pneumoperitoneum is established through the SPIDER device, and the device is fully inserted and docked in place. The outer diameter of the SPIDER device is 18mm. A 5mm bariatric length scope is used through the SPIDER device for visualization. A rigid, bariatric length grasper is utilized through the SPIDER device to grasp the gallbladder and elevate the fundus throughout the case. Flexible instruments are then introduced through the flexible channels of the SPIDER device to complete the Cholecystectomy. A flexible grasper provides lateral retraction from the left instrument channel, while flexible maryland dissector, hook cautery, clip applier and scissors are used through the right instrument channel. The cystic duct and cystic artery are clipped using a flexible clip applier which utilizes Hem-o-lok® ML clips (Teleflex , Limerick, PA). The gallbladder is removed from the liver bed utilizing flexible monopolar hook cautery. The specimen is grasped and removed when the SPIDER device is removed from the abdomen.

Results: A total of 40 cholecystectomies were done by a single surgeon utilizing the SPIDER Surgical System through a 18mm incision at the umbilicus. The mean age of patients was 43 years old (+/- 18 standard deviation, 19 min, 82 max). The mean total operative time was 71 minutes (+/- 29 standard deviation, 33 min, 145 max). The mean total operative time of the first 20 cases was 85 minutes (includes learning curve), and the mean total operative time of the second 20 cases was 58 minutes. The mean follow up period was 138 days (+/- 107 standard deviation, 10 min, 349 max). No interoperative or post-op complications were observed. No cases were converted to open, and in 3 cases an additional 5mm port was added to aide in the completion of the case.

Conclusions: The SPIDER® Surgical System appears feasible as a single incision system to reliably perform cholecystectomies. Further study of this novel technology is recommended.