title: Robotic single-site cholecystectomy in the obese: outcomes from a single institution.
abstract: BACKGROUND
  Robotic single-site cholecystectomy (RSSC) has been shown to be a safe alternative to the laparoscopic approach in selected patients. Patient exclusion criteria have prevented RSSC as a surgical option in many obese patients. This study reports the feasibility of performing RSSC in obese patients (body mass index [BMI] ≥ 30).
  
  
  METHODS
  Between November 2012 and February 2014, a total of 200 patients underwent RSSC at our institution. All patients were offered the robotic procedure regardless of their BMI, age, previous surgery, and acuity of their disease with no exclusion criteria. All patients with BMI ≥ 30 were included in the study and were compared to nonobese patients for demographic characteristics, co-morbidities, and postoperative outcomes. Data were compared to RSSC performed in nonobese patients by the same surgeon, as well to published data for standard laparoscopic cholecystectomy (LC).
  
  
  RESULTS
  A total of 112 cholecystectomies were successfully performed with the robotic approach in patients with BMI ≥ 30 without conversion to open, laparoscopic, or multiport procedures. The mean BMI was 39.5 (range 30.1-62.3). Twenty-eight patients had a BMI ≥ 40 (25%), and 13 patients had a BMI ≥ 50 (11.6%). Fifty-two patients (46.4%) had a history of prior abdominal surgery. Most procedures were nonelective (78.6%) with patients presenting with acute symptoms. Pathology showed chronic cholecystitis and cholelithiasis in 79 patients (70.5%), acute cholecystitis in 26 patients (23.3%), cholelithiasis in 4 patients (3.5%), and gangrenous cholecystitis in 3 patients (2.7%). Total mean operative time was 69.8 (26) minutes for obese patients compared to 59.2 (19.7) minutes in the nonobese, which was statistically significant (P = .0012). After a mean follow-up of 6 months, there were no major complications recorded including bile leak, hematoma, or ductal injury. There was 1 umbilical (incisional) hernia (0.9%) reported, and zero wound infections. When comparing RSSC performed in obese patients, RSSC in nonobese patients, and published data for standard LC, we found no difference in operative time, with less conversion to open.
  
  
  CONCLUSIONS
  Robotic single-site cholecystectomy is a feasible option in the obese patient population with excellent short-term outcomes. Patients should not be excluded based on their high BMI although further study is needed to determine long-term outcomes.
authors.affiliation: Department of Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Shane
authors.initials: S
authors.lastname: Svoboda
authors.affiliation: Department of Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: T Robert
authors.initials: TR
authors.lastname: Qaqish
authors.affiliation: Department of Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Ana
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Department of Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Habeeba
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland. Electronic address: yyoussef@lifebridgehealth.org.
authors.forename: Yassar
authors.initials: Y
authors.lastname: Youssef
mesh_terms: D015992:Body Mass Index; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D041881:Cholecystitis, Acute / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications* / Q000503:physiopathology; D061646:Operative Time; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013997:Time Factors
keywords: Acute cholecystitis; Biliary colic; Cholecystectomy; Gallbladder; Gallstone pancreatitis; Minimally invasive; Obesity laparoscopic; Overweight; Robotic single-site cholecystectomy; Robotic surgery