Dan Eisenberg, MD1, Nathan Hansen, MD2, Eric Kubat, MD2, Huy Nguyen, DO3, Sherry M Wren, MD1. 1Stanford School of Medicine and Palo Alto VA HCS, 2Palo Alto VA HCS, 3Advanced Surgical Associates of San Jose
Background: Laparoendoscopic single incision surgery is technically and ergonomically challenging. Robotic surgery has the potential of overcoming these challenges of laparoscopic single site surgery.
Hypothesis: SSRC can be performed safely with a short learning curve. We present a large series of SSRC by a single surgeon in a community hospital.
Patients and Methods: We performed a retrospective review of a prospective database of a single surgeon’s experience with consecutive patients, presenting for cholecystectomy in a community hospital.
Results: Of 150 patients who underwent SSRC between May 2012 and August 2013, 65% were female; most of Asian and Hispanic descent (51.3% and 39.3%, respectively). Their mean age was 54±17.6 years with an average BMI of 27±6.5 kg/m2. Of all operations, 74 (49.3%) were non-elective/urgent. The mean total operative time was 83.3±33.1 minutes. Operative time ranged from 32 to 212 minutes. Early in the surgeon’s experience the mean OR time was 94.8 minutes for the first 50 cases. This dropped to an average of 77.7 minutes in the following 100 cases (figure 1). There were 6 (4%) early postoperative complications, which included one (0.7%) conversion to multiport laparoscopy, then to open cholecystectomy due to extensive local inflammation. In this case, a duct injury at the confluence of the cystic and common bile ducts was identified. Two patients had respiratory complications (1.3%), 2 patients developed fever and bacteremia (1.3%), and 1 patient had a prolonged ileus that delayed discharge (0.7%). Median hospital stay was 1 day. Thirty day mortality was 0%. Average duration of follow up was 17.4 months (range 9-24 months). Six patients (4%) developed a surgical site infection, 1 patient (0.7%) suffered a myocardial infarction 2 weeks after surgery, and retained CBD stones requiring ERCP were seen in 2 patients (1.3%). Fascial dehiscence was seen in none of the patients (0%).
Conclusion: SSRC is safe, has a reasonable learning curve, and can be performed in a community hospital setting with morbidity comparable to laparoscopic cholecystectomy. However, it is associated with a higher risk of local wound complications.
[Figure 1. Operative time]