A comparison of robotic single-incision and traditional single-incision laparoscopic cholecystectomy

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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“…Two comparative studies reported on costs [173, 174]. One study reported comparable costs of instruments ($1268 for SIRC and $1282 for SILC).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2019

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“…Previous studies also reported that robotic cholecystectomy required more medical cost than laparoscopic cholecystectomy, and there may be differences in the total medical cost among other countries. 17,18 As mentioned before, the costs of the routine preoperative examinations and hospital fees are the same between robotic and laparoscopic groups. 9 Efforts will be needed to reduce the surgery-related costs in SIRC through the development of various robotic systems and their competitions.…”

Section: Discussionmentioning

confidence: 90%

“…Similar to the present results, previous studies demonstrated the safety and feasibility of SIRC compared with SILC or 3PLC. [16][17][18] Although it was difficult to obtain a critical view of safety (CVS) in some SILC cases because of limitation of cross movement of instruments, the CVS was obtained in all the cases and then the surgery was proceeded.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Kim

Han

Kang

et al. 2018

J Minim Invasive Surg

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Robotic-associated minimally invasive surgery is a novel method for overcoming some limitations of laparoscopic surgery. This study aimed to evaluate the outcomes (postoperative pain, cosmesis, surgeon's workload) of single-incision robotic cholecystectomy (SIRC) vs. single-incision laparoscopic cholecystectomy (SILC) vs. conventional three-port laparoscopic cholecystectomy (3PLC). Methods: 134 patients who underwent laparoscopic or robotic cholecystectomy at a single center during 2016~2017 were enrolled. Prospectively collected data included demographics, operative outcomes, questionnaire regarding pain and cosmesis, and NASA-Task Load Index (NASA-TLX) scores for surgeon's workload. Results: 55 patients underwent SIRC, 29 SILC, and 50 3PLC during the same period. 3PLC patient group was older than the others (SIRC vs. SILC vs. 3PLC: 48.1 vs. 42.2 vs. 54.1 years, p<0.001). Operative time was shortest with 3PLC (44.1 vs. 38.8 vs. 25.4 min, p<0.001). Estimated blood loss, postoperative complications, and postoperative stay were similar among the groups. Pain control was lowest in the 3PLC group (98.2% vs. 100% vs. 84.0%, p=0.004), however, at 2 weeks postoperatively there were no differences among the groups (p=0.374). Cosmesis scores were also worst after 3PLC (17.5 vs. 18.4 vs. 13.3, p<0.001). NASA-TLX score was highest in the SILC group (21.9 vs. 44.3 vs. 25.2, p<0.001). Conclusion: Although SIRC and SILC take longer than 3PLC, they produce superior cosmetic outcomes. Compared with SILC, SIRC is more ergonomic, lowering the surgeon's workload. Despite of higher cost, SIRC could be an alternative for treating gallbladder disease in selected patients.

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“…6 For single-incision robotic cholecystectomy (SIRC), there are debates regarding operation time, with some authors reporting a longer operation time for SIRC than SILS (98 vs 68 min, p<0.001). 7 Conversely, a significant difference in operation time was reported for RSSC (62 min) and SILS (83 min). 8 A recent multicenter study showed a short operative time of RSSC of 52 min with a decreasing trend after 55~85 cases.…”

mentioning

confidence: 99%

“…In the present study, the operation time was 97.2 min, the console time was 49 min, and the docking time was 10 min, which is similar to other reports. 7,10 The authors also described a decreasing trend of console time with accumulation of experience, indicating the potential to overcome the long operation time of SIRC.…”

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confidence: 99%

Single-incision Robotic Cholecystectomy: Initial Experience and Results

Kim

2017

J Minim Invasive Surg

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EDITORIALAlthough there have been many studies of the safety or feasibility of single-incision laparoscopic surgery (SILS) since it was first performed in 1997, 1 most surgeons agree that it has disadvantages such as difficulty conducting triangulation, instrument crowding, and collisions. [2][3][4] To overcome these limitations of laparoscopy, the robotic platform was developed, providing advantages including three-dimensional view, magnification, and an articulated instrument.5 However, robotic surgery requires a longer set-up time and operation time than laparoscopy.6 For single-incision robotic cholecystectomy (SIRC), there are debates regarding operation time, with some authors reporting a longer operation time for SIRC than SILS (98 vs 68 min, p<0.001).7 Conversely, a significant difference in operation time was reported for RSSC (62 min) and SILS (83 min).8 A recent multicenter study showed a short operative time of RSSC of 52 min with a decreasing trend after 55~85 cases. 9 However, that study was limited in that it did not include a comparative analysis for SIRC. In the present study, the operation time was 97.2 min, the console time was 49 min, and the docking time was 10 min, which is similar to other reports.7,10 The authors also described a decreasing trend of console time with accumulation of experience, indicating the potential to overcome the long operation time of SIRC.The first single-incision robotic cholecystectomy (SIRC) was successfully performed in humans in 2010, 11 and the safety and feasibility of SIRC have since been published in many reports. Moreover, there have been no severe complications, such as injury to the bile duct or conversion to laparoscopy or open surgery, 11,12 although one case of postoperative hemorrhage associated with SIRC has been reported. 13 Additionally, some authors have investigated cosmetic outcome and postoperative pain in comparative studies, 14,15 with less pain and better cosmetic outcomes occurring in SILC. 16,17 The results of the present study also showed good outcomes without any conversions or complications, even when no additional port was used during the procedure. In another recent study, the authors reported their experience of SIRC in a broadly inclusive patient population with six conversions to laparoscopy, one to open surgery, and one aborted case.18 Here, we focus on indications of SIRC. The surgical outcome in earlier studies was excellent because the initial inclusion criteria in most studies were limited in symptomatic gallstones or gallbladder polyps, and did not include high BMI or acute cholecystitis. 6,8 To clarify the effectiveness of SIRC, operative indications should be extended in all cases of gallbladder diseases. However, gallbladder retraction is not easy in cases of edematous or dense Corresponding author

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A comparison of robotic single-incision and traditional single-incision laparoscopic cholecystectomy

Abstract: While RSILC can be safely performed, it is associated with longer operative times and greater cost.

Cited by 26 publications

References 14 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

Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Single-incision Robotic Cholecystectomy: Initial Experience and Results

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