Aaron D Carr, MD, Gina N Farinholt, MD, Tamas J Vidovszky, MD, Mohamed R Ali, MD
University of California, Davis
Introduction
Single site robotic cholecystectomy (SSRC) has only been available for 8 months in the United States. As early adopters of this technique, we present our experience with the technical aspects, patient outcomes, and learning curve of SSRC.
Methods
We prospectively collected demographic, anthropomorphic, procedural, and outcome data on patients who underwent SSRC at our institution since January 2012. Procedural data included the time required to dock the robot (docking time [DT]), the time required to perform cholecystectomy at the control console (console time [CT]), the duration of use of the robot from docking to undocking (total robotic time [TRT]), and total operative time (TOT). We offered SSRC to all patients deemed candidates for laparoscopic cholecystectomy, without any specific exclusion criteria.
Results
The study population consisted of 59 patients who were predominantly female (n=40, 68%) and had mean age of 45.9±7.4 (16-77) years and mean body mass index (BMI) of 30.2±17 (18.4-51.6) kg/m2. The indications for SSRC were symptomatic cholelithiasis (n=52, 88%), biliary dyskinesia (n=3, 5.1%), cholecystitis (n=2, 3.4%), adenomyomatosis (n=1, 1.7%), and recurrent pyogenic cholecystitis (n=1, 1.7%).
Overall, mean TOT was 87.9±31 (31-200) minutes, mean DT was 5.2±3.0 (1-22) minutes, and mean CT was 39.1±17 (15-93) minutes. Patients with BMI≥30 kg/m2 (n=29) had longer mean TOT than patients with BMI<30 kg/m2 (n=30) (101±42 min vs 79±21 min, p=0.014). Patients who had previous abdominal surgery (PAS) (n=21, 36%), intra-abdominal adhesions (ADH) (N=14, 24%), or cholecystitis (CHOLE) (n=3, 5.1%) had higher TOT (101±44 min vs 81±21 min, p= 0.024) and BMI (33±8.4 kg/m2 vs 28±5.8 kg/m2, p=0.017) than patients who did not.
Conversion from SSRC was required in 6 (10.1%) patients: 5 conversions to laparoscopy and 1 conversion to open. Although all 6 patients had BMI≥30 kg/m2, only one conversion was related to body habitus. The other 5 conversions were due to bleeding (n=2), dense adhesions (n=2), and gallbladder inflammation (n=1).
In the 53 operations that were completed robotically, PAS, ADH, or CHOLE did not impact TRT (46±15 min vs 44±19 min, p=0.71) or CT (41±15 min vs 38±19 min, p=0.58), and obesity (BMI≥30 kg/m2) did not affect TRT (48±17.9 min vs 42±1 .4 min, p=0.26) or CT (43±18.0 min vs 36±16.5 min, p=0.18). Regression analysis of the learning curves demonstrated improvement in TRT and CT over the course of the study.
Most patients (n=51, 86.4%) were discharged on the day of surgery. Hospital admission was required for monitoring of comorbidities or drains (n=5) and further imaging based on intraoperative findings (n=3). There were 6 hospital readmissions for common bile duct (CBD) sludge (n=2), retained CBD stone (n=1), constipation (n=1), hypoglycemia (n=1), and infected biloma (n=1) that required laparoscopic drain placement. There were no bile duct injuries.
Conclusions
SSRC is safe and has a manageable learning curve. Patient factors such as PAS, ADH, CHOLE, and obesity did not directly affect conversion rates or robotic operative times. SSRC is a promising new technique, which can be offered to a wide array of patients.
Session: Poster Presentation
Program Number: P646
