Chan W Park, MD, Hector R Herrera Cabral, MD, Roberto J Manson, MD, Aurora D Pryor, MD. Duke Endosurgery, Department of Surgery, Duke University
Single port cholecystectomy is one of the more commonly performed single site/access surgeries and is accomplished with a variety of techniques. However, single port surgery is often limited by poor visualization and ineffective or difficult triangulation. The TransEnterix SPIDER system can overcome many of these challenges of single site surgery, and has previously been shown to be effective in a porcine model. We present our initial experiences and results from human cases.
Seven patients with confirmed diagnosis of symptomatic cholelithiasis or gall bladder polyps (confirmed by right upper quadrant ultrasound and laboratory testing) underwent successful single port laparoscopic cholecystectomy with the SPIDER system; performed by one of two surgeons. One surgeon had extensive training with the system and one was an experienced laparoscopic surgeon without any previous SPIDER experience. Operative times and peri-operative complications were recorded at the time of surgery. All patients were followed for the first 24 hours, at 2 weeks, and 1 month post-operatively.
There were no mortalities or significant morbidities associated with single port laparoscopic cholecystectomy using the SPIDER system. All cases were successfully completed by the operating surgeon within an average operating time of 63 minutes (range 42-82 minutes). No ancillary ports or punctures were required. Two patients had acute cholecystitis, and the remainder had gallstones or polyps without acute disease. Subjectively, patients related little pain compared to standard laparoscopic cholecystectomy. Cosmetically, all incisions were hidden in the umbilicus. No wound complications were evident at any post-operative evaluation.
The TransEnterix SPIDER can be used safely and successfully for single port laparoscopic cholecystectomy. The system appears to be intuitive and easily adopted by an experienced laparoscopic surgeon. Prospective randomized studies are underway to confirm benefits relating to cosmesis and post-operative pain.
Program Number: S051