Yonsei Med J.  2015 Jan;56(1):189-195. 10.3349/ymj.2015.56.1.189.

The First Experiences of Robotic Single-Site Cholecystectomy in Asia: A Potential Way to Expand Minimally-Invasive Single-Site Surgery?

• Lee SH
• Jung MJ
• Hwang HK
• Kang CM
• Lee WJ

• KMID: 2352806
• DOI: http://doi.org/10.3349/ymj.2015.56.1.189

Abstract

PURPOSE
Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy.
MATERIALS AND METHODS
From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC).
RESULTS
Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group.
CONCLUSION
RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.

Keyword

Robotic; single-site; single port; cholecystectomy

MeSH Terms

Adult
Asia
Blood Loss, Surgical
Cholecystectomy, Laparoscopic/instrumentation/*methods
Dissection
Female
Fluorescence
Gallbladder Diseases/surgery
Humans
Intraoperative Care
Male
Middle Aged
Minimally Invasive Surgical Procedures/instrumentation/*methods
Operative Time
Robotics/instrumentation/*methods

Figure

• 

  Fig. 1 Robotic single-site instrumentation. (A) Specialized single port for robotic single-site surgery. (B) 8.5-mm camera port (left) and 5-mm assist port (right). (C) Flexible robotic instrument with curved robotic cannula. Note there is no angulated motion of the effector instrument (arrowed). (D) Schematic configuration of camera and curved cannula.

• 

  Fig. 2 Intraoperative Firefly™ Fluorescence Imaging. (A) Ambiguous bile duct anatomy was observed in the typical view for the robotic single-site system. (B) Firefly™ Fluorescence Imaging, which was used to safely guide the robotic cholecystectomy, identified a dilated cystic duct and an obscured common bile duct (CBD). GB, gallbladder.

• 

  Fig. 3 Change in actual dissection time and estimated blood loss with RSSC. (A) Serial change of actual dissection time (min) for RSSC. (B) Serial change of blood loss (mL) for RSSC. RSSC, robotic single-site cholecystectomy.

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