Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: protocol for a randomized controlled trial.
BACKGROUND
Recent advances in robotic technology suggest that the utilization of the da Vinci Single-Site™ platform for cholecystectomy is safe, feasible and results in a shorter learning curve compared to conventional single-incision laparoscopic cholecystectomy. Moreover, the robot-assisted technology has been shown to reduce the surgeon's stress load compared to standard single-incision laparoscopy in an experimental setup, suggesting an important advantage of the da Vinci platform. However, the above-mentioned observations are based solely on case series, case reports and experimental data, as high-quality clinical trials to demonstrate the benefits of the da Vinci Single-Site™ cholecystectomy have not been performed to date.


METHODS
This study addresses the question whether robot-assisted Single-Site™ cholecystectomy provides significant benefits over single-incision laparoscopic cholecystectomy in terms of surgeon's stress load, while matching the standards of the conventional single-incision approach with regard to peri- and postoperative outcomes. It is designed as a single centre, single-blinded randomized controlled trial, which compares both surgical approaches with the primary endpoint surgeon's physical and mental stress load at the time of surgery. In addition, the study aims to assess secondary endpoints such as operating time, conversion rates, additional trocar placement, intra-operative blood loss, length of hospital stay, costs of procedure, health-related quality of life, cosmesis and complications. Patients as well as ward staff are blinded until the 1stpostoperative year. Sample size calculation based on the results of a previously published experimental setup utilizing an estimated effect size of surgeon's comfort of 0.8 (power of 0.8, alpha-error level of 0.05, error margin of 10-15%) resulted in a number of 30 randomized patients per arm.


CONCLUSIONS
The study is the first randomized controlled trial that compares the da Vinci Single Site™ platform to conventional laparoscopic approaches in cholecystectomy, one of the most frequently performed operations in general surgery.


BACKGROUND
This trial is registered at clinicaltrials.gov (trial number: NCT02485392 ). Registered February 19, 2015.
Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Lukasz Filip
LF
Grochola
Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Christopher
C
Soll
Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Adrian
A
Zehnder
Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Roland
R
Wyss
Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland.
Pascal
P
Herzog
Department of Surgery, Cantonal Hospital of Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland. stefan.breitenstein@ksw.ch.
Stefan
http://orcid.org/0000-0002-9673-2788
S
Breitenstein
D016063:Blood Loss, Surgical; D002763:Cholecystectomy / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D059032:Learning Curve; D007902:Length of Stay; D061646:Operative Time; D011788:Quality of Life; D012371:Robotics / Q000379:methods*; D016037:Single-Blind Method
Cholecystectomy; Robot-assisted laparoscopy; Single Site; Single incision; Stress load; Surgeon’s Comfort; da Vinci