Single-site robotic cholecystectomy

Background: Laparoscopic single-incision surgery is fraught with significant technical drawbacks but has witnessed increased growth mainly for its presumed aesthetic advantages. Recently, a single-site robotic platform has been introduced to alleviate some of the technical challenges with laparoscopic single-site surgery, although literature on this topic is scant. The aim of this study is to analyze the experience of a single surgeon with single-site robotic cholecystectomies since the U.S. Food and Drug Administration gave its approval in December 2011, and to evaluate the robotic platform’s safety and short-term surgical outcomes. Methods: From February 1st 2012 to February 28th 2013, patients who underwent single-site cholecystectomy at an academic institution in the United States were retrospectively reviewed from a prospectively maintained database. The following variables were analyzed: age, sex, body mass index, previous surgeries, total operative time, port insertion time, docking time, console time, estimated blood loss, closure time, conversion to open or multiport approach, postoperative outcomes for wound infection, bile leak, biliary ductal injury, right hepatic artery injury, reoperations, readmission, and mortality. Indication for cholecystectomy was symptomatic gallbladder disease. No exclusion criteria were used and no cost analysis was performed. Results: During the study period, 31 patients were enrolled. The mean patient age, body mass index, weight, and operative time was 33.6 years, 32.2 kg/m², 86.3 kg, and 81.4 minutes, respectively. There were no conversions to the open or traditional multiport approach, and no major complications of biliary ductal or hepatic artery injury, bile leak, reoperations, or mortality occurred. There was 1 case of superficial wound infection. Conclusions: Single-site robotic cholecystectomy is feasible and safe and requires a minimal learning curve to transition from traditional multiport to single-port robotic cholecystectomy.