Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2022; 14(12): 769-776
Published online Dec 16, 2022. doi: 10.4253/wjge.v14.i12.769
Our initial single port robotic cholecystectomy experience: A feasible and safe option for benign gallbladder diseases
Huseyin Kemal Rasa, Ayhan Erdemir
Huseyin Kemal Rasa, Ayhan Erdemir, Department of General Surgery, Anadolu Medical Center Hospital, Kocaeli 41400, Turkey
Author contributions: Rasa HK contributed to conceptualization of the study, methodology, writing, review and editing of the manuscript, and project administration; Erdemir A contributed to conceptualization of the study, methodology, formal analysis of the data, investigation into the literature and writing of the original draft of the manuscript; both authors read and approved the final manuscript.
Institutional review board statement: The study was conducted following the Declaration of Helsinki (as revised in 2013) and was approved by Anadolu Medical Center Hospital review board and ethics committee (ASM-EK-22/186).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Data sharing statement: The datasets analyzed during the current study are available in the hospital’s “electronic patient records” and from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Huseyin Kemal Rasa, MD, Attending Doctor, Department of General Surgery, Anadolu Medical Center Hospital, Cumhuriyet Mahallesi 2255 Sokak No 3 Gebze, Kocaeli 41400, Turkey. kemrasa@gmail.com
Received: September 22, 2022
Peer-review started: September 22, 2022
First decision: October 20, 2022
Revised: November 25, 2022
Accepted: December 1, 2022
Article in press: December 1, 2022
Published online: December 16, 2022
Abstract
BACKGROUND

Although single-port laparoscopic cholecystectomy has been performed for over 25 years, it is still not popular. The narrow working space used in this surgery limits the movement of instruments and causes ergonomic challenges. Robotic surgery not only resolves the ergonomic challenges of single-port laparoscopic surgery but is also considered a good option with its additional technical advantages, like a three-dimensional display and not being affected by tremors. However, the extent to which these technical and ergonomic advantages positively affect the surgical outcomes and how safe the single-port robotic surgeries need to be assessed for each particular surgery.

AIM

To evaluate the feasibility and safety of single-port robotic cholecystectomy for patients with cholelithiasis.

METHODS

The electronic records of the first 40 consecutive patients with gallbladder lithiasis who underwent single-port robotic cholecystectomy from 2013 to 2021 were analyzed retrospectively. In addition to the demographic characteristics of the patients, we analyzed American Society of Anesthesiologists (ASA) scores and body mass index. The presence of an accompanying umbilical hernia was also noted. The amount of blood loss during the operation, the necessity to place a drain in the subhepatic area, and the need to use grafts during the closure of the fascia of the port site were determined. Hospital stay, readmission rates, perioperative and postoperative complications, the Clavien-Dindo complication scores and postoperative analgesia requirements were also evaluated.

RESULTS

The mean age of the 40 patients included in the study was 49.5 ± 11.6 years, and 26 were female (65.0%). The umbilical hernia was present in 24 (60.0%) patients, with a body mass index median of 29.3 kg/m2 and a mean of 29.7 ± 5.2 kg/m2. Fifteen (37.5%) of the patients were evaluated as ASA I, 18 (45.0%) as ASA II, and 7 (17.5%) as ASA III. The mean bleeding amount during the operation was 58.4 ± 55.8 mL, and drain placement was required in 12 patients (30.0%). After port removal, graft reinforcement during fascia closure was preferred in 14 patients (35.0%). The median operation time was 93.5 min and the mean was 101.2 ± 27.0 min. The mean hospital stay was 1.4 ± 0.6 d, and 1 patient was readmitted to the hospital due to pain (2.5%). Clavien-Dindo I complications were seen in 14 patients (35.0%), and five (12.5%) complications were wound site problems.

CONCLUSION

In addition to the technological and ergonomic advantages robotic surgery provides surgeons, our study strongly supports that single-port robotic cholecystectomy is a feasible and safe option for treating patients with gallstones.

Keywords: Cholecystectomy, Laparoscopic cholecystectomy, Robotic surgery, Single-port surgery, Single-port laparoscopic cholecystectomy, Single-port robotic cholecystectomy

Core Tip: We retrospectively analyzed 40 consecutive patients with cholelithiasis who underwent single-port robotic cholecystectomy from 2013 to 2021. We believe that the learning curve for single-port robotic cholecystectomy surgery is not long, and after a particular experience, the operation times are significantly shortened. Our data suggest that it is a safe surgery with acceptable intraoperative blood loss, no conversion, and no bile duct injury or postoperative bile leak. Our data also support more liberal graft use during the fascia closure. Single-port robotic cholecystectomy is a feasible and safe option that should be considered when treating patients with gallstones.