Ann Hepatobiliary Pancreat Surg.  2025 May;29(2):140-149. 10.14701/ahbps.24-198.

Comparative analysis of postoperative outcomes of single-incision cholecystectomy: Propensity score matching of robotic surgery using the da Vinci SP system and da Vinci Xi system vs. laparoscopic surgery

• Park JI
• Chung YK
• Lee YM
• Nam CW
• Nah YW

• KMID: 2568262
• DOI: http://doi.org/10.14701/ahbps.24-198

Abstract

Backgrounds/Aims
We compared the postoperative outcomes of single-incision laparoscopic cholecystectomy (SILC) with those of single-incision robotic cholecystectomy (SIRC) using the da Vinci Xi and SP systems.
Methods
We retrospectively analyzed data from 206 patients who underwent these procedures by a single surgeon between August 2020 and April 2022. Propensity score matching was used to adjust for confounders and evaluate outcomes.
Results
SILC exhibited shorter operation times compared to SIRC with Xi and SP (44.9 ± 14.5 min vs. 55.3 ± 12.2 min vs. 55.2 ± 16.2 min, p < 0.001). SIRC with Xi had shorter docking times (6.2 ± 2.8 min vs. 10.3 ± 2.3 min, p < 0.001), while SIRC with SP demonstrated reduced console times (11.2 ± 2.4 min vs. 18.6 ± 8.0 min, p < 0.001). Pain scores and complications did not significantly differ between the groups.
Conclusions
Both SILC and SIRC showed comparable outcomes, with the SP system providing advantages such as reduced console time and fully articulated arms, likely reducing surgeon stress.

Keyword

Cholecystectomy; Single-incision; Laparoscopy; Robotic

Figure

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  Fig. 1 Single-incision laparoscopic cholecystectomy. (A) The first assistant uses a flexible laparoscope, while the second assistant uses forceps to grasp the gallbladder fundus and a snake retractor to retract the liver. Positioned between the patient’s legs, the operator employs a single instrument. (B) The second assistant performs gallbladder traction and liver retraction to fully expose Calot’s triangle. (C) A 2.5-cm skin incision is made at the umbilicus.

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  Fig. 2 Single-port access device of the da Vinci Xi system. (A, B) A straight robotic cannula for the camera is positioned in the midline of the single port, flanked by two curved cannulas on each side in a crossed configuration.

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  Fig. 3 Single-incision robotic cholecystectomy using the da Vinci SP system. (A) The da Vinci SP platform is docked to the entry guide cannula. (B) The entry guide cannula features four openings; the upper opening accommodates the camera, the left opening houses the fenestrated bipolar forceps (arm 1), the lower opening supports the round tooth retractor (arm 2), and the right opening is designated for the monopolar curved scissors (arm 3). (C) The da Vinci SP system comprises one flexible camera and three robotic arms, each equipped with two joints. (D) The operational field with the da Vinci SP system provides optimal exposure of Calot’s triangle, akin to that achieved in single-incision laparoscopic cholecystectomy with assistance from two assistants.

Reference

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