Robotic Single-Port Laparoscopic Cholecystectomy Is Safe but Faces Technical Challenges.
BACKGROUND
For cholecystectomy, multiport laparoscopy is the recommended surgical approach. Single-port laparoscopy (SPL) was introduced to reduce postoperative pain and provide better cosmetic results, but has technical disadvantages. Robotic SPL (RSPL) was developed to overcome these disadvantages. In this prospective study, we aim to describe intraoperative results and postoperative outcomes of RSPL cholecystectomies and evaluate technical aspects of the technique.


METHODS
A prospective database of all patients who underwent a RSPL cholecystectomy between January 2012 and December 2014 was analyzed. Intraoperative results and postoperative complications were evaluated.


RESULTS
A total of 27 patients underwent RSPL cholecystectomy. Median age was 59 (20-78) years and median body mass index was 25 (19-35) kg/m2. The majority of patients had American Society of Anesthesiologists (ASA) II classification (67%) and 89% underwent surgery for cholecystolithiasis or cholecystitis. The median operating time was 81 (41-115) minutes. Conversion to a multiport procedure occurred in 2; one due to insufficient length of the robotic instruments. In the second and third patients, conversion to an open procedure was necessary due to inadequate exposure caused by liver cirrhosis and purulent ascites, respectively. In seven procedures, spill occurred due to rupture of the gallbladder. Postoperative complications occurred in 4 patients, including 1 bleeding (no reintervention), 1 peritonitis, and 2 wound infections. After a median follow-up of 33 (10-44) months, 5 (19%) trocar-site hernias were seen.


CONCLUSIONS
RSPL cholecystectomy is feasible, however, encountered by technical challenges due to inadequate length of the nonwristed robotic instruments. A high incidence of gallbladder rupture and trocar-site hernias may limit its application.
Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
Yoen T K
YT
van der Linden
Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
Hylke J F
HJ
Brenkman
Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
Sylvia
S
van der Horst
Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
Wilhelmina M U
WM
van Grevenstein
Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
Richard
R
van Hillegersberg
Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands .
Jelle P
JP
Ruurda
D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D041761:Cholecystolithiasis / Q000601:surgery*; D061887:Conversion to Open Surgery; D016208:Databases, Factual; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery; D006555:Hernia, Ventral / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000517:prevention & control; D010538:Peritonitis / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013525:Surgical Instruments; D013530:Surgical Wound Infection / Q000453:epidemiology; D055815:Young Adult
cholecystectomy; robotics; single-port laparoscopy