Telerobotic-assisted laparoscopic cholecystectomy: our experience on 29 patients.
OBJECTIVE
The role of computer-assisted surgery (CAS) is still debated and not clearly defined.


METHODS
The authors report their initial experience with CAS, comparing 29 patients submitted to cholecystectomy, using a Zeus remote-controlled robot and an Aesop remote voice-activated endoscope robot, with 29 patients submitted to standard laparoscopic cholecystectomy (LC). The surgical field and the arms of the robot were under the direct and real-time control of the surgeon, who stayed at the workstation and maneuvered the Zeus, using joysticks. The workstation was in the same room as the patient.


RESULTS
Twenty-nine patients underwent telerobotic-assisted cholecystectomy (TLAC); 1 procedure was converted to standard LC and 1 to open cholecystectomy. The conversions were due to choledocholithiasis and cholecystitis. During TLAC, the mean operating time and transition time (from the induction of anesthesia to incision of the skin) were, respectively, 75 min (range, 60-170 min) and 45 min (range, 25-60 min). We did not observe any complications related to TLAC. The limitations of TLAC were the lack of tactile feedback, the increase in surgical time, and the expensive cost of the procedure to reach the same result as that of LC.


CONCLUSIONS
After this initial experience, we believe that TLAC could be considered only for training in CAS, but that it is without advantages in terms of its higher cost compared with LC.
Caratozzolo
Ezio
E
Fourth Unit of Surgery, Regional Reference Center of Hepato-Biliary-Pancreatic Surgery, Regional Hospital Cà Foncello Piazza Ospedale, 31100, Treviso, Italy.
Recordare
Alfonso
A
Massani
Marco
M
Bonariol
Luca
L
Jelmoni
Alessandro
A
Antoniutti
Michele
M
Bassi
Nicolò
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D002764:Cholecystitis / Q000150:complications; D042883:Choledocholithiasis / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000191:economics / Q000295:instrumentation / Q000379:methods*