title: Solo-surgical laparoscopic cholecystectomy with a joystick-guided camera device: a case-control study.
abstract: BACKGROUND
  This study aimed to evaluate the implementation of a joystick-controlled camera holder (Soloassist; Actormed, Barbing, Germany) in laparoscopic cholecystectomy as so-called solo-surgery compared with the standard operation.
  
  
  METHODS
  Of the 123 patients included in this study, 63 underwent laparoscopic cholecystectomy using the Soloassist system and were compared with 60 patients who underwent laparoscopic cholecystectomy with human assistance. The two groups did not differ significantly in terms of age, sex, body mass index, or American Society of Anesthesiology classification. The surgeons were divided into those highly experienced and those experienced with the new camera holder. The operation times were measured, including setup and dismantling of the system. The assessment also included complications, postoperative hospital stay, measurement of human resources in terms of personnel/minutes/operation, and subjective evaluation of the camera-guiding device by the surgeons.
  
  
  RESULTS
  The hospital stay and operation-related complications were not enhanced in the Soloassist group. The differences in core operation time (p = 0.008) and total operating time (p = 0.001) significantly favored the human assistant. Whereas the absolute duration of surgery was longer, the relative operating time (in personnel/minutes/operation) was significantly shorter (p < 0.001). In 4.8 % of the cases, the operation could not be performed completely with the camera-holding device. Clinically relevant postoperative complications did not occur. The experience of the surgeons did not differ significantly. The subjective evaluation regarding handling, image quality, effort, and satisfaction demonstrated high acceptance of the Soloassist system.
  
  
  CONCLUSIONS
  The camera-guiding device can be implemented without increased complications. The Soloassist system is safe and can be operated even by colleagues without system experience. All the surgeons rated their satisfaction with the system as very good to excellent. Although the operating times were longer than with the standard camera guidance, the absolute overall staff time was reduced.
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Gillen
authors.forename: Benedikt
authors.initials: B
authors.lastname: Pletzer
authors.forename: Arthur
authors.initials: A
authors.lastname: Heiligensetzer
authors.forename: Petra
authors.initials: P
authors.lastname: Wolf
authors.forename: Jörg
authors.initials: J
authors.lastname: Kleeff
authors.forename: Hubertus
authors.initials: H
authors.lastname: Feussner
authors.forename: Alois
authors.initials: A
authors.lastname: Fürst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D005858:Germany; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D012371:Robotics / Q000295:instrumentation*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult