title: Robotic cholecystectomy: learning curve, advantages, and limitations.
abstract: BACKGROUND
  Robotic cholecystectomy is safe, feasible procedure. Initial studies showed significant set up time and operating time but no clear clinical advantage of the robotic involvement. We have investigated the learning curve, advantages and limitation of the procedure.
  
  
  METHODS
  We reviewed all (n = 51) robotic cholecystectomies performed between July 2004 and December 2005. The surgery was performed using the da Vinci system. We recorded operative time, setup time of robotics instrumentation, conversion to laparoscopic or open cholecystectomy and complication of the procedure.
  
  
  RESULTS
  Forty-eight of the 51 procedures (94%) were completed robotically. We did not experience any significant complications directly related to robotics surgery. The mean +/- SD operating time was 77 +/- 22.3 min. The mean setup time for robotics (from incision until robot was in place, including draping the robot) was 24 +/- 8.8 min. However, the setup time significantly improved as we gained more experience: from 30.6 +/- 10.7 min (first 16 cases) to 18.3 +/- 4.0 min (cases 33-48). The mean robotic time was 34 +/- 16.1 min. We observed no significant improvement in robotic procedure time.
  
  
  CONCLUSIONS
  Robotic cholecystectomy offers significant advantages such as three-dimensional view, easier instrument manipulations and possibility of remote site surgery. We observed some shortcomings of robotic surgery such as need for larger and additional ports, and need for undocking the machine in case of cholangiography or change of patient position. Our data shows that the learning curve is between 16 to 32 procedures to significantly decrease the setup time and total operating time.
authors.affiliation: Department of Surgery, University of California, Davis, California 95817, USA. tamas.vidovszky@ucdmc.ucdavis.edu
authors.forename: Tamas J
authors.initials: TJ
authors.lastname: Vidovszky
authors.forename: William
authors.initials: W
authors.lastname: Smith
authors.forename: Jagannath
authors.initials: J
authors.lastname: Ghosh
authors.forename: Mohamed R
authors.initials: MR
authors.lastname: Ali
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000193:education* / Q000295:instrumentation* / Q000379:methods; D006804:Ergonomics; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional; D007396:Internship and Residency; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome