James A Radford, DC, MS1, Aliu Sanni, MD2. 1Philadelphia College of Osteopathic Medicine, 2Augusta University
INTRODUCTION: Single-Incision Laparoscopic Cholecystectomy (SILC) was developed to decrease abdominal peritoneal trauma, decrease postoperative pain and to improve cosmetic outcomes over traditional multiport laparoscopic cholecystectomy. It however has several technical limitations, such as lack of triangulation, cross handling and instrument collision. With the advent of Single-Incision Robotic Cholecystectomy (SIRC), these limitations were overturned while retaining the benefits of the single incision. The aim of this review is to evaluate the post-operative outcomes of SIRC as it compares to SILC.
METHODS: A systematic review was conducted through PubMed to identify relevant studies from January 2011 to December 2016 with comparative data on single-incision laparoscopic cholecystectomy vs single-incision robotic cholecystectomy. The primary outcomes analyzed were postoperative pain, postoperative complications (bile leakage, port site infection, incisional hernia, periumbilical cellulitis, incidence of intraabdominal abscess and abdominal wall hematomas) and length of hospital stay. The secondary outcomes assessed included conversion rate to an open procedure and surgical operative times. Results are expressed as standard difference in means with standard error. Statistical analysis was done using fixed-effects meta-analysis to compare the mean value of the separate groups (Comprehensive Meta-Analysis Version 3.3.070 software; Biostat Inc., Englewood, NJ).
RESULTS: Four studies were quantitatively assessed and included for meta-analysis. Among the four studies, 298 patients underwent single-incision laparoscopic cholecystectomy and 280 patients underwent single-incision robotic cholecystectomy. There was a significant reduction in postoperative pain levels (-2.322, 0.243, P=0.001) with single-incision robotic cholecystectomy as well as significantly longer operative times (0.657, 0.089, P=0.001) when compared to single-incision laparoscopic cholecystectomy. There were no significant differences in length of hospital stay (-0.014, 0.090, p=0.880), conversion to open procedure (-0.130, 0.144, p=0.367) or postoperative complications (-0.056, 0.008, P=0.531).
CONCLUSIONS: Postoperative pain levels are significantly reduced following single-incision robotic cholecystectomy when compared to single-incision laparoscopic cholecystectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79994
Program Number: P673
Presentation Session: Poster (Non CME)
Presentation Type: Poster
