title: The first experiences of robotic single-site cholecystectomy in Asia: a potential way to expand minimally-invasive single-site surgery?
abstract: OBJECTIVE
  Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventional laparoscopic single-site cholecystectomy.
  
  
  METHODS
  From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomes with our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC).
  
  
  RESULTS
  Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisons with SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis, and American Society of Anesthesiologist score showed no significant differences between two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperative pain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertion or open conversion cases in either group.
  
  
  CONCLUSIONS
  RSSC provides a comfortable environment and improved ergonomics to laparoscopic single-site cholecystectomy; however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Korea.
authors.forename: Sung Hwan
authors.initials: SH
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Korea.
authors.forename: Myung Jae
authors.initials: MJ
authors.lastname: Jung
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Korea.
authors.forename: Ho Kyoung
authors.initials: HK
authors.lastname: Hwang
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Korea. cmkang@yuhs.ac.
authors.forename: Chang Moo
authors.initials: CM
authors.lastname: Kang
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Severance Hospital, Seoul, Korea.
authors.forename: Woo Jung
authors.initials: WJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D001208:Asia; D016063:Blood Loss, Surgical; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D004210:Dissection; D005260:Female; D005453:Fluorescence; D005705:Gallbladder Diseases / Q000601:surgery; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D012371:Robotics / Q000295:instrumentation / Q000379:methods*
keywords: Robotic; cholecystectomy; single port; single-site