Ann Hepatobiliary Pancreat Surg.  2025 Feb;29(1):48-54. 10.14701/ahbps.24-137.

ArtiSential^® laparoscopic cholecystectomy versus singlefulcrum laparoscopic cholecystectomy: Which minimally invasive surgery is better?

• Jeong JH
• Hong SS
• Choi M
• Rho SY
• Radkani P
• Goh BKP
• Nagakawa Y
• Tanabe M
• Asano D
• Kang CM

• KMID: 2565406
• DOI: http://doi.org/10.14701/ahbps.24-137

Abstract

Backgrounds/Aims
In recent years, many minimally invasive techniques have been introduced to reduce the number of ports in laparoscopic cholecystectomy (LC), offering benefits such as reduced postoperative pain and improved cosmetic outcomes. ArtiSential^® is a new multi-degree-of-freedom articulating laparoscopic instrument that incorporates the ergonomic features of robotic surgery, potentially overcoming the spatial limitations of laparoscopic surgery. ArtiSential^® LC can be performed using only two ports. This study aims to compare the surgical outcomes of ArtiSential^® LC with those of single-fulcrum LC.
Methods
This retrospective study compared ArtiSential^® LC and single-fulcrum LC among LCs performed for gallbladder (GB) stones at the same center, analyzing the basic characteristics of patients; intraoperative outcomes, such as operative time, estimated blood loss, and intraoperative GB rupture; and postoperative outcomes, such as length of hospital stay, incidence of postoperative complications, and postoperative pain.
Results
A total of 88 and 63 patients underwent ArtiSential^® LC and single-fulcrum LC for GB stones, respectively. Analysis showed that ArtiSential^® LC resulted in significantly fewer cases of surgeries longer than 60 minutes (30 vs. 35 min, p = 0.009) and intraoperative GB ruptures (2 vs. 10, p = 0.007). In terms of postoperative outcomes, ArtiSential^® LC showed better results in the respective visual analog scale (VAS) scores immediately after surgery (2.59 vs. 3.73, p < 0.001), and before discharge (1.44 vs. 2.02, p = 0.01).
Conclusions
ArtiSential^® LC showed better results in terms of surgical outcomes, especially postoperative pain. Thus, ArtiSential^® LC is considered the better option for patients, compared to single-fulcrum LC.

Keyword

Laparoscopy; Cholecystectomy; Gallbladder; Minimally invasive surgical procedures

Figure

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  Fig. 1 External view in a single-fulcrum laparoscopic cholecystectomy.

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  Fig. 2 Operating room layout of the operator and assistant when performing ArtiSential® laparoscopic cholecystectomy.

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  Fig. 3 Port site schematic figure (Glove port; Jirehlapa Korea).

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  Fig. 4 A detailed surgical procedure for ArtiSential® laparoscopic cholecystectomy. (A) The gallbladder is retracted superiorly with a 5-mm grasper held by the assistant (green arrow), and the Hartmann’s pouch is retracted with bipolar fenestrated forceps to expose the Calot triangle (yellow arrow). (B) Calot’s triangle is dissected, and the cystic duct and cystic artery are isolated. (C) The cystic duct and cystic artery ligated using the ArtiSential® clip applicator. (D) Detachment of the gallbladder from the liver in a medial to lateral direction prevents instrument collision.

Reference

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