A Comparative Study of Outcomes Between Single‐Site Robotic and Multi‐port Laparoscopic Cholecystectomy: An Experience from a Tertiary Care Center

Balachandran, Banujan; Hufford, Theadore; Mustafa, Taha; Kochar, Kunal; Sulo, Suela; Khorsand, Joubin

doi:10.1007/s00268-016-3799-0

Cited by 38 publications

(24 citation statements)

References 45 publications

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“…The literature search identified thirteen studies with a total of 1411 patients [170–182]. Two studies were randomized controlled trials [170, 171] (n = 136 and n = 60), and three were non-randomized comparative studies [172–174] (n = 790). The two RCTs and a large non-randomized study (n = 678) compared SIRC with multi-port laparoscopic cholecystectomy (MPLC).…”

Section: Resultsmentioning

confidence: 99%

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

et al. 2019

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BackgroundLaparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges.MethodsAn expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria.ResultsIn general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies.ConclusionsConsidering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.

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Section: Resultsmentioning

confidence: 99%

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

et al. 2019

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“…Robotic cholecystectomy (Table 1) [1][2][3][4][5][6][7][8][9][10][11][12][13] With the current platform available, two major approaches are used: single site and multi-port. We reviewed the current literature and found 2,039 cases listed in the time frame we choose.…”

Section: Resultsmentioning

confidence: 99%

“…1 When used for benign disease, chronic cholecystitis, or biliary dyskinesia, it has been proven to be an acceptable alternative to traditional cholecystectomy in terms of outcomes, although it is more expensive. 2 When compared to single site laparoscopy, the robotic system developed with the Da Vinci Si/Xi© platform gives the surgen or a surgen a huge advantage of wristed instruments with controlled torque. This might be associated with less postoperative discomfort.…”

Section: Discussionmentioning

confidence: 99%

Robotic surgery for liver, pancreas, and bile duct pathologies: A critical analysis and personal views

Matteotti

2019

Gastrointestinal Intervention

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At the beginning of this millennium robotic surgery was launched and quickly became accepted in many surgical specialties. Initially only resection procedures were performed with a few surgical steps made towards reconstructive elements. Robotic surgery helped to overcome disadvantages seen and experienced when performing laparoscopic procedures, mainly lack of haptic feedback, lack of 'free movement' in the abdominal cavity and inferior visualization. Since its initiation, robotic surgery was utilized more and more in complex procedures. Its use in complex liver and pancreatic surgery is still controversial as it requires a high volume center and superb training to achieve acceptable results. Robotic surgery for hepato-pancreato-biliary disease is only performed by a few centers in the United States. A team approach is mandatory and the bed side assistant is as important as the console surgeon in achieving acceptable oncological outcome. This article aims to review the most recent literature and gives some personal views into the near future with anticipated development of this exciting technology.

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“…In several trials comparing single‐incision port with multiple‐port procedures, researchers have demonstrated that single‐incision port procedures result in longer operative times, in part because of lack of triangulation. Despite this, a difference in complication rates between single‐incision–port and multiple‐port procedures has not been shown in most human studies, although, in one retrospective study, a higher infection rate was observed in cholecystectomy patients undergoing a single‐incision–port robotic procedure than in patients undergoing a multiple‐port procedure . In a study of 98 dogs undergoing laparoscopic gastropexies and/or ovariectomies, single‐incision–port procedures were found to have significantly shorter operative times compared with multiple‐port procedures; however, there was no difference in complication rates …”

Section: Discussionmentioning

confidence: 99%

Paramedian incisional complications after prophylactic laparoscopy‐assisted gastropexy in 411 dogs

et al. 2019

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Objective To determine the frequency and types of paramedian incisional complications after prophylactic laparoscopy‐assisted gastropexy (LAG) in dogs and to evaluate potential risk factors for complications. Study design Multi‐institutional retrospective study. Animals Client‐owned dogs (N = 411). Methods Records for dogs that underwent single‐incision–port laparoscopy‐assisted gastropexy (SIPLAG) or multiple‐port laparoscopy‐assisted gastropexy (MPLAG) at five veterinary referral hospitals were reviewed. Information regarding signalment, surgical procedures, perioperative care, and incisional complications was collected. Follow‐up information was obtained by review of medical records and/or communication with owners. Potential risk factors for complications were examined statistically. Results Paramedian incisional complications were observed in 78 of 411 (19%) dogs. The most common complication was seroma formation, which occurred in 51 (12.4%) dogs. Surgical site infections were observed in 16 (3.9%) dogs, and dehiscence or development of excessive scar tissue at the incision site were each observed in nine (2.2%) dogs. Complications resolved with conservative treatment in 75 of 78 (96.2%) dogs and with surgical treatment in three of 78 (3.8%) dogs. The odds of complications were approximately twice as high in dogs undergoing SIPLAG than in dogs undergoing MPLAG (odds ratio, 2.03; P = .006). Conclusion Minor paramedian incisional complications, particularly seroma formation, were frequently observed after LAG. Most complications were successfully managed conservatively. Single‐incision–port laparoscopy‐assisted gastropexy was associated with a higher complication rate compared with MPLAG. Clinical significance Owners should be informed that there is a relatively high rate of minor paramedian incisional complications after LAG. The risk of complications appears to be higher for SIPLAG than for MPLAG.

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A Comparative Study of Outcomes Between Single‐Site Robotic and Multi‐port Laparoscopic Cholecystectomy: An Experience from a Tertiary Care Center

Cited by 38 publications

References 45 publications

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery

Robotic surgery for liver, pancreas, and bile duct pathologies: A critical analysis and personal views

Paramedian incisional complications after prophylactic laparoscopy‐assisted gastropexy in 411 dogs

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