First results after introduction of the four-armed da Vinci Surgical System in fully robotic laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy offers less post-operative pain, less complications, and faster recovery compared with open cholecystectomy. However, laparoscopic surgery can be demanding because of several technical drawbacks. Robotic surgery allows dexterity skills to be performed faster and shortens the learning curve, possibly leading to faster and safer laparoscopic surgery.


METHODS
In this paper, we report the results of our first 12 cases of fully robotic laparoscopic cholecystectomy using the da Vinci Surgical System, comparing them with 12 cases of conventional laparoscopic cholecystectomy. Using a fourth arm in robotic laparoscopy enables the surgeon to perform surgery without the use of a tableside assistant, leading to non-tiring, tremble-free assistance and reducing salary costs. Primary end points are operating time and costs. Secondary end points are operative complications and duration of admission.


RESULTS
Fully robotic cholecystectomy was completed in all 12 cases without increased complication rate and without conversions. However, robotic assistance results in an increased overall operating room stay of 31 min and increased costs of EUR 1,180.62.


CONCLUSIONS
Fully robotic laparoscopic cholecystectomy is safe and feasible but seems more expensive and time consuming at this moment.
Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands. Heemsch@hetnet.nl
Jeroen
J
Heemskerk
Ronald
R
van Dam
Wim G
WG
van Gemert
Gerard L
GL
Beets
Jan Willem M
JW
Greve
Michael J H M
MJ
Jacobs
Nicole D
ND
Bouvy
D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D012371:Robotics; D013997:Time Factors