title: Urgent and Elective Robotic Single-Site Cholecystectomy: Analysis and Learning Curve of 150 Consecutive Cases.
abstract: BACKGROUND
  The use of robotic single-site cholecystectomy has increased exponentially. There are few reports describing the safety, efficacy, and operative learning curve of robotic single-site cholecystectomy either in the community setting or with nonelective surgery.
  
  
  METHODS
  We performed a retrospective review of a prospective database of our initial experience with robotic single-site cholecystectomy. Demographics and perioperative outcomes were evaluated for both urgent and elective cholecystectomy. Cumulative sum analysis was performed to determine the surgeon's learning curve.
  
  
  RESULTS
  One hundred fifty patients underwent robotic single-site cholecystectomy. Seventy-four (49.3%) patients underwent urgent robotic single-site cholecystectomy, and 76 (50.7%) underwent elective robotic single-site cholecystectomy. Mean total operative time for robotic single-site cholecystectomy was 83.3 ± 2.7 minutes. Mean operative time for the urgent cohort was significantly longer than for the elective cohort (95.0 ± 4.4 versus 71.9 ± 2.6 minutes; P < .001). There was one conversion in the urgent cohort and none in the elective cohort. There was one bile duct injury (0.7%) in the urgent cohort. Perioperative complications occurred in 8.7% of patients, and most consisted of superficial surgical-site infections. There were no incisional hernias detected. The surgeon's learning curve, inclusive of urgent and elective cases, was 48 operations.
  
  
  CONCLUSIONS
  Robotic single-site cholecystectomy can be performed safely and effectively in both elective and urgent cholecystectomy with a reasonable learning curve and acceptable perioperative outcomes.
authors.affiliation: 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California.
authors.forename: Eric
authors.initials: E
authors.lastname: Kubat
authors.affiliation: 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California.
authors.forename: Nathan
authors.initials: N
authors.lastname: Hansen
authors.affiliation: 2 Department of Surgery, Regional Medical Center , San Jose, California.
authors.forename: Huy
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California.
authors.forename: Sherry M
authors.initials: SM
authors.lastname: Wren
authors.affiliation: 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California.
authors.forename: Dan
authors.initials: D
authors.lastname: Eisenberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*