J Minim Invasive Surg.  2018 Dec;21(4):168-176. 10.7602/jmis.2018.21.4.168.

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

• Kim HS
• Han Y
• Kang JS
• Lee DH
• Kim JR
• Kwon W
• Kim SW
• Jang JY

• KMID: 2429390
• DOI: http://doi.org/10.7602/jmis.2018.21.4.168

Abstract

PURPOSE
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.

Keyword

Robotic Cholecystectomy; Laparoscopic Cholecystectomy; Pain; Body image; Workload

MeSH Terms

Body Image
Cholecystectomy*
Cholecystectomy, Laparoscopic*
Demography
Gallbladder Diseases
Humans
Laparoscopy
Methods
Minimally Invasive Surgical Procedures
Operative Time
Pain, Postoperative*
Postoperative Hemorrhage
Prospective Studies