title: Cosmesis, patient satisfaction, and quality of life after da Vinci Single-Site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial.
abstract: Single-incision laparoscopic cholecystectomy evolved from the traditional multiport laparoscopic technique. Prior trials have demonstrated improved cosmesis with the single-incision technique. Robotic single-site surgery minimizes the technical difficulties associated with laparoscopic single-incision approach. This is the first prospective, randomized, controlled study comparing robotic single-site cholecystectomy (RSSC) and multiport laparoscopic cholecystectomy (MPLC) in terms of cosmesis and patient satisfaction.
  
  
  
  Patients with symptomatic benign gallbladder disease were randomized to RSSC or MPLC. Data included perioperative variables such as operative time, conversion and complications and cosmesis satisfaction, body image perception, quality of life using validated questionnaires, at postoperative visits of 2, 6 weeks and 3 months.
  
  
  
  One hundred thirty-six patients were randomized to RSSC (N = 83) and MPLC (N = 53) at 8 institutions. Both cohorts were dominated by higher enrollment of females (RSSC = 78%, MPLC = 92%). The RSSC and MPLC cohorts were otherwise statistically matched. Operative time was longer for RSSC (61 min vs. 44 min, P < 0.0001). There were no differences in complication rates. RSSC demonstrated a significant superiority in cosmesis satisfaction and body image perception (P value < 0.05 at every follow-up). There was no statistically significant difference in patient-reported quality of life. Multivariate analysis of female patients demonstrated significantly higher preference for RSSC over MPLC in cosmesis satisfaction and body image perception with no difference seen in overall quality of life.
  
  
  
  Results from this trial show that RSSC is associated with improved cosmesis satisfaction and body image perception without a difference in observed complication rate. The uncompromised safety and the improved cosmesis satisfaction and body image perception provided by RSSC for female patients support consideration of the robotic single-site approach. ClinicalTrials.gov identifier NCT01932216.
authors.affiliation: Tufts University School of Medicine, Boston, MA, USA. omar.kudsi@tufts.edu.|, One Pearle Street, Suite 2000, Brockton, MA, 02301, USA. omar.kudsi@tufts.edu.
authors.forename: Omar Yusef
authors.identifier: 0000-0001-6723-0909
authors.initials: OY
authors.lastname: Kudsi
authors.affiliation: Drexel University College of Medicine, Philadelphia, PA, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Castellanos
authors.affiliation: JFK Medical Center, Lake Worth, FL, USA.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kaza
authors.affiliation: St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: McCarty
authors.affiliation: Hillcrest Medical Center, Tulsa, OK, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Dickens
authors.affiliation: Huntington Hospital, Pasadena, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.affiliation: West Suburban Medical Center, Oak Park, IL, USA.
authors.forename: Frederick M
authors.initials: FM
authors.lastname: Tiesenga
authors.affiliation: Athens Medical Center, Athens, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Konstantinidis
authors.affiliation: Athens Medical Center, Athens, Greece.
authors.forename: Petros
authors.initials: P
authors.lastname: Hirides
authors.affiliation: Intuitive Surgical Clinical Affairs, Sunnyvale, CA, USA.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Mehendale
authors.affiliation: Baptist Hospital South Florida, Miami, FL, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D000368:Aged; D001828:Body Image; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D065287:Robotic Surgical Procedures / Q000379:methods*; D012371:Robotics / Q000379:methods; D011795:Surveys and Questionnaires
keywords: Cosmesis; Laparoscopy; Multiport cholecystectomy; Quality of life; Robotic-assisted surgery; Single-port cholecystectomy