Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):78-83. 10.14701/ahbps.2021.25.1.78.

Comparison of outcomes of single incision robotic cholecystectomy and single incision laparoscopic cholecystectomy

Affiliations
  • 1Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Abstract

Backgrounds/Aims
Multiport laparoscopic cholecystectomy is the standard surgical procedure for symptomatic gallbladder diseases. However, as a result of the ongoing trend toward minimally invasive laparoscopy, single-incision laparoscopic cholecystectomy (SILC) has evolved. Single-incision robotic cholecystectomy (SIRC) can overcome several limitations of manual SILC. The purpose of this study is to evaluate and compare the safety and feasibility of SIRC and SILC.
Methods
This study retrospectively reviewed data for all patients who underwent SIRC or SILC from March 2018 to July 2019 in a single institution. The following variables were analyzed: age, sex, body mass index, pain scale, length of stay, and complications. The data were analyzed using the Independent two sample t-test or the Fisher’s exact test.
Results
A total of 343 patients underwent SIRC or SILC during the study period. After excluding patients with acute cholecystitis, 197 SIRC and 103 SILC patients were analyzed in this study. The surgery time and postoperative hospital stay did not differ between SIRC and SILC. However, the SIRC patients experienced less bile spillage during the surgery than did the SILC patients (SIRC vs. SILC: 24 (23.3%) vs. 11 (5.6%) cases, respectively; p<0.001). Although there was no difference in the incidence of postoperative complications between procedures, additional pain control was administered more frequently in SILC patients (SILC 1.08±0.893, SIRC 0.58±0.795; p<0.001).
Conclusions
While both SILC and SIRC are effective for single-incision cholecystectomy, SIRC was superior to SILC in terms of technical stability. Moreover, it has the advantage of postoperative pain control.

Keyword

Single incision cholecystectomy; Single port cholecystectomy; Robot assisted cholecystectomy; Laparoscopic cholecystectomy

Reference

1. Lee B, Suh SW, Choi Y, Han HS, Yoon YS, Cho JY, et al. 2019; Solo single incision laparoscopic cholecystectomy using the parallel method; surgical technique reducing a steep learning curve. Ann Hepatobiliary Pancreat Surg. 23:344–352. DOI: 10.14701/ahbps.2019.23.4.344. PMID: 31825000. PMCID: PMC6893057.
Article
2. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. 1997; One-wound laparoscopic cholecystectomy. Br J Surg. 84:695. DOI: 10.1046/j.1365-2168.1997.02586.x. PMID: 9393287.
Article
3. Duza G, Davrieux CF, Palermo M, Khiangte E, Azfar M, Rizvi SAA, et al. 2019; conventional laparoscopic appendectomy versus single-port laparoscopic appendectomy, a multicenter randomized control trial: a feasible and safe alternative to standard laparoscopy. J Laparoendosc Adv Surg Tech A. 29:1577–1584. DOI: 10.1089/lap.2019.0460. PMID: 31613689.
Article
4. Patel AG, Murgatroyd B, Ashton WD. 2012; Single incision laparoscopic adjustable gastric banding: 111 cases. Surg Obes Relat Dis. 8:747–751. DOI: 10.1016/j.soard.2011.06.013. PMID: 21890429.
Article
5. Hirano Y, Hiranuma C, Hattori M, Douden K, Yamaguchi S. 2020; Single-incision or single-incision plus one-port laparoscopic surgery for colorectal cancer. Surg Technol Int. 36:132–135. DOI: 10.1007/s12262-020-02465-8. PMID: 32196563.
6. Omori T, Yamamoto K, Hara H, Shinno N, Yamamoto M, Sugimura K, et al. 2020; A randomized controlled trial of single-port versus multi-port laparoscopic distal gastrectomy for gastric cancer. Surg Endosc. doi: 10.1007/s00464-020-07955-0. [in press]. DOI: 10.1007/s00464-020-07955-0. PMID: 32886237.
Article
7. Lee YJ, Moon JI, Choi IS, Lee SE, Sung NS, Kwon SW, et al. 2018; A large-cohort comparison between single incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy from a single center; 2080 cases. Ann Hepatobiliary Pancreat Surg. 22:367–373. DOI: 10.14701/ahbps.2018.22.4.367. PMID: 30588528. PMCID: PMC6295377.
Article
8. Subirana H, Rey FJ, Barri J, Robres J, Parra L, Martín M, et al. 2020; Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting: a prospective randomised double-blind controlled trial. J Minim Access Surg. doi: 10.4103/jmas.JMAS_97_20. [in press]. DOI: 10.4103/jmas.JMAS_97_20. PMID: 32964868.
Article
9. Brown KM, Moore BT, Sorensen GB, Boettger CH, Tang F, Jones PG, et al. 2013; Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: a randomized prospective trial. Surg Endosc. 27:3108–3115. DOI: 10.1007/s00464-013-2914-7. PMID: 23519495.
Article
10. Lee SH, Jung MJ, Hwang HK, Kang CM, Lee WJ. 2015; The first experiences of robotic single-site cholecystectomy in Asia: a potential way to expand minimally-invasive single-site surgery? Yonsei Med J. 56:189–195. DOI: 10.3349/ymj.2015.56.1.189. PMID: 25510764. PMCID: PMC4276755.
Article
11. Migliore M, Arezzo A, Arolfo S, Passera R, Morino M. 2018; Safety of single-incision robotic cholecystectomy for benign gallbladder disease: a systematic review. Surg Endosc. 32:4716–4727. DOI: 10.1007/s00464-018-6300-3. PMID: 29943057.
Article
12. Kroh M, El-Hayek K, Rosenblatt S, Chand B, Escobar P, Kaouk J, et al. 2011; First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surg Endosc. 25:3566–3573. DOI: 10.1007/s00464-011-1759-1. PMID: 21638179.
Article
13. Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, DeNoto G, et al. 2013; Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg. 216:1037–1047. discussion 1047–1048. DOI: 10.1016/j.jamcollsurg.2013.02.024. PMID: 23619321.
14. Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, DeNoto G, et al. 2012; Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc. 26:1296–1303. DOI: 10.1007/s00464-011-2028-z. PMID: 22083331.
Article
15. Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. 2019; Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial. Surg Endosc. 33:1482–1490. DOI: 10.1007/s00464-018-6430-7. PMID: 30218263.
Article
16. Han DH, Choi SH, Kang CM, Lee WJ. 2020; Propensity score-matching analysis for single-site robotic cholecystectomy versus single-incision laparoscopic cholecystectomy: a retrospective cohort study. Int J Surg. 78:138–142. DOI: 10.1016/j.ijsu.2020.04.042. PMID: 32334076.
Article
17. Lee HY, Kim YH, Jung GJ, Roh YH, Park SY, Kang NU, et al. 2012; Prognostic factors for gallbladder cancer in the laparoscopy era. J Korean Surg Soc. 83:227–236. DOI: 10.4174/jkss.2012.83.4.227. PMID: 23091795. PMCID: PMC3467389.
Article
18. Blakely AM, Wong P, Chu P, Warner SG, Raoof M, Singh G, et al. 2019; Intraoperative bile spillage is associated with worse survival in gallbladder adenocarcinoma. J Surg Oncol. 120:603–610. DOI: 10.1002/jso.25617. PMID: 31292970.
Article
19. Clemente G, Nuzzo G, De Rose AM, Giovannini I, La Torre G, Ardito F, et al. 2012; Unexpected gallbladder cancer after laparoscopic cholecystectomy for acute cholecystitis: a worrisome picture. J Gastrointest Surg. 16:1462–1468. DOI: 10.1007/s11605-012-1915-5. PMID: 22653330.
Article
20. Horkoff MJ, Ahmed Z, Xu Y, Sutherland FR, Dixon E, Ball CG, et al. 2021; Adverse outcomes after bile spillage in incidental gallbladder cancers: a population-based study. Ann Surg. 273:139–144. DOI: 10.1097/SLA.0000000000003325. PMID: 30998534.
21. Peponis T, Eskesen TG, Mesar T, Saillant N, Kaafarani HMA, Yeh DD, et al. 2018; Bile spillage as a risk factor for surgical site infection after laparoscopic cholecystectomy: a prospective study of 1,001 patients. J Am Coll Surg. 226:1030–1035. DOI: 10.1016/j.jamcollsurg.2017.11.025. PMID: 29501782.
Article
22. Rice DC, Memon MA, Jamison RL, Agnessi T, Ilstrup D, Bannon MB, et al. 1997; Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy. J Gastrointest Surg. 1:85–90. discussion 90–91. DOI: 10.1007/s11605-006-0014-x. PMID: 9834334.
Article
23. Kaloo P, Armstrong S, Kaloo C, Jordan V. 2019; Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrane Database Syst Rev. 1:CD011101. DOI: 10.1002/14651858.CD011101.pub2. PMID: 30699235. PMCID: PMC6353625.
Article
24. Cunningham TK, Draper H, Bexhell H, Allgar V, Allen J, Mikl D, et al. 2020; A double-blinded randomised controlled study to investigate the effect of intraperitoneal levobupivacaine on post laparoscopic pain. Facts Views Vis Obgyn. 12:155–161. PMID: 33123690. PMCID: PMC7580260.
25. Lee J, Kim KH, Lee TY, Ahn J, Kim SJ. 2020; Robotic surgery enables safe and comfortable single-incision cholecystectomy: a comparison of robotic and laparoscopic approaches for single-incision surgery. J Minim Access Surg. doi: 10.4103/jmas. JMAS_274_19. [in press]. DOI: 10.4103/jmas.JMAS_274_19. PMID: 33047682.
26. Lim JH, Lee WJ, Choi SH, Kang CM. 2020; Cholecystectomy using the Revo-i robotic surgical system from Korea: the first clinical study. Updates Surg. doi: 10.1007/s13304-020-00877-5. [in press]. DOI: 10.1007/s13304-020-00877-5. PMID: 32936390.
Article
27. Posada Calderon L, Al Hussein Al Awamlh B, Shoag J, Patel N, Nicolas JD, Scherr DS. 2021; The role of surgical experience in patient selection, surgical quality, and outcomes in robot-assisted radical cystectomy. Urol Oncol. 39:6–12. DOI: 10.1016/j.urolonc.2020.08.009. PMID: 33127299.
Article
28. Arezzo A, Passera R, Forcignanò E, Rapetti L, Cirocchi R, Morino M. 2018; Single-incision laparoscopic cholecystectomy is responsible for increased adverse events: results of a meta-analysis of randomized controlled trials. Surg Endosc. 32:3739–3753. DOI: 10.1007/s00464-018-6143-y. PMID: 29523982.
Article
29. Hall TC, Dennison AR, Bilku DK, Metcalfe MS, Garcea G. 2012; Single-incision laparoscopic cholecystectomy: a systematic review. Arch Surg. 147:657–666. DOI: 10.1001/archsurg.2012.814. PMID: 22802063.
30. Sun N, Zhang JL, Zhang CS, Li XH, Shi Y. 2018; Single-incision robotic cholecystectomy versus single-incision laparoscopic cholecystectomy: a systematic review and meta-analysis. Medicine (Baltimore). 97:e12103. DOI: 10.1097/MD.0000000000012103. PMID: 30200093. PMCID: PMC6133478.
Full Text Links
  • AHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr