World Journal of Surgery

, Volume 41, Issue 5, pp 1246–1253 | Cite as

A Comparative Study of Outcomes Between Single-Site Robotic and Multi-port Laparoscopic Cholecystectomy: An Experience from a Tertiary Care Center

  • Banujan Balachandran
  • Theadore A. Hufford
  • Taha Mustafa
  • Kunal Kochar
  • Suela Sulo
  • Joubin Khorsand
Original Scientific Report



The aim of this study was to compare the outcomes of single-site robotic cholecystectomy with multi-port laparoscopic cholecystectomy within a high-volume tertiary health care center.


A retrospective analysis of prospectively maintained data was conducted on patients undergoing single-site robotic cholecystectomy or multi-port laparoscopic cholecystectomy between October 2011 and July 2014. A single surgeon performed all the surgeries included in the study.


A total of 678 cholecystectomies were performed. Of these, 415 (61%) were single-site robotic cholecystectomies and 263 (39%) were multi-port laparoscopic cholecystectomies. Laparoscopic patients had a greater mean BMI (30.5 vs. 29.0 kg/m2; p = 0.008), were more likely to have undergone prior abdominal surgery (83.3 vs. 41.4%; p < 0.001) and had a higher incidence of preexisting comorbidities (76.1 vs. 67.2%; p = 0.014) as compared to the robotic group. There was no statistical difference in the total operative time, rate of conversion to open procedure and mean length of follow-up between the two groups. The mean length of hospital stay was shorter for patients within the robotic group (1.9 vs. 2.4 days; p = 0.012). Single-site robotic cholecystectomy was associated with a higher rate of wound infection (3.9 vs. 1.1%; p = 0.037) and incisional hernia (6.5 vs. 1.9%; p = 0.006).


Multi-port laparoscopic cholecystectomy should remain the gold standard therapy for gallbladder disease. Single-site robotic cholecystectomy is an effective alternative procedure for uncomplicated benign gallbladder disease in properly selected patients. This must be carefully balanced against a high rate of surgical site infection and incisional hernia, and patients should be informed of these risks.


Chronic Obstructive Pulmonary Disease Laparoscopic Cholecystectomy Incisional Hernia Gallbladder Disease Total Operative Time 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to acknowledge Dr. John J. Park MD, Associate Program Director of Minimally Invasive Colon and Rectal Surgery Fellowship at Advocate Lutheran General Hospital for editing the manuscript and his mentorship throughout the study. We would also like to thank the efforts of Mrs. Olympia Katsabanis for her logistical support throughout the data collection and manuscript preparation process.

Compliance with ethical standards

Conflict of interest

Mr. Balachandran, Dr. Hufford, Dr. Mustafa, Dr. Kochar, Dr. Sulo and Dr. Khorsand have no conflicts of interest or financial ties to disclose.


  1. 1.
    Reynolds W Jr (2001) The first laparoscopic cholecystectomy. J Soc Laparoendosc Surg 5:89–94Google Scholar
  2. 2.
    Curcillo PG 2nd, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A, Dunham R, Fendley S, Neff M, Copper C, Bessler M, Gumbs AA, Norton M, Iannelli A, Mason R, Moazzez A, Cohen L, Mouhlas A, Poor A (2010) Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860CrossRefPubMedGoogle Scholar
  3. 3.
    Mutter D, Callari C, Diana M, Dallemagne B, Leroy J, Marescaux J (2011) Single port laparoscopic cholecystectomy: which technique, which surgeon, for which patient? A study of the implementation in a teaching hospital. J Hepato-Biliary-Pancreat Sci 18:453–457CrossRefGoogle Scholar
  4. 4.
    Prasad A, Mukherjee KA, Kaul S, Kaur M (2011) Postoperative pain after cholecystectomy: conventional laparoscopy versus single-incision laparoscopic surgery. J Minim Access Surg 7:24–27PubMedPubMedCentralGoogle Scholar
  5. 5.
    Wren SM, Curet MJ (2011) Single-port robotic cholecystectomy: results from a first human use clinical study of the new da Vinci single-site surgical platform. Arch Surg 146:1122–1127CrossRefPubMedGoogle Scholar
  6. 6.
    Allemann P, Leroy J, Asakuma M, Al Abeidi F, Dallemagne B, Marescaux J (2010) Robotics may overcome technical limitations of single-trocar surgery: an experimental prospective study of Nissen fundoplication. Arch Surg 145:267–271CrossRefPubMedGoogle Scholar
  7. 7.
    Pietrabissa A, Sbrana F, Morelli L, Badessi F, Pugliese L, Vinci A, Klersy C, Spinoglio G (2012) Overcoming the challenges of single-incision cholecystectomy with robotic single-site technology. Arch Surg 147:709–714CrossRefPubMedGoogle Scholar
  8. 8.
    Miller DW, Schlinkert RT, Schlinkert DK (2004) Robot-assisted laparoscopic cholecystectomy: initial Mayo clinic Scottsdale experience. Mayo Clin Proc 79:1132–1136CrossRefPubMedGoogle Scholar
  9. 9.
    Ross SB, Sawangkum P, de La Vega KA, Teta A, Luberice K, Rosemurgy AS (2013) Single-site robotic cholecystectomy (SSRC): an initial review of safety and feasibility. Minerva Chir 68:435–443PubMedGoogle Scholar
  10. 10.
    Lanfranco AR, Castellanos AE, Desai JP, Meyers WC (2004) Robotic surgery: a current perspective. Ann Surg 239:14–21CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Schirmer BD, Winters KL, Edlich RF (2005) Cholelithiasis and cholecystitis. J Long Term Eff Med Implants 15:329–338CrossRefPubMedGoogle Scholar
  12. 12.
    Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243CrossRefPubMedGoogle Scholar
  13. 13.
    Mak PH, Campbell RC, Irwin MG, American Society of Anesthesiologists (2002) The ASA physical status classification: inter-observer consistency. Anaesth Intensive Care 30:633–640PubMedGoogle Scholar
  14. 14.
    Aronson WL, McAuliffe MS, Miller K (2003) Variability in the American Society of Anesthesiologists Physical Status Classification Scale. AANA J 71:265–274PubMedGoogle Scholar
  15. 15.
    Riley R, Holman C, Fletcher D (2014) Inter-rater reliability of the ASA physical status classification in a sample of anaesthetists in Western Australia. Anaesth Intensive Care 42:614–618PubMedGoogle Scholar
  16. 16.
    Haynes SR, Lawler PG (1995) An assessment of the consistency of ASA physical status classification allocation. Anaesthesia 50:195–199CrossRefPubMedGoogle Scholar
  17. 17.
    Srivastava A, Niranjan A (2010) Secrets of safe laparoscopic surgery: anaesthetic and surgical considerations. J Minim Access Surg 6:91–94CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Kama NA, Kologlu M, Doganay M, Reis E, Atli M, Dolapci M (2001) A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg 181:520–525CrossRefPubMedGoogle Scholar
  19. 19.
    Frazee RC, Roberts JW, Symmonds R, Snyder SK, Hendricks J, Smith R, Custer MD (1992) What are the contraindications for laparoscopic cholecystectomy? Am J Surg 164:491–494 (discussion 494–495) CrossRefPubMedGoogle Scholar
  20. 20.
    Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM (1997) Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg 21:629–633. doi: 10.1007/PL00012288 CrossRefPubMedGoogle Scholar
  21. 21.
    Chung PJ, Huang R, Policastro L, Lee R, Schwartzman A, Alfonso A, Sugiyama G (2015) Single-site robotic cholecystectomy at an inner-city academic center. J Soc Laparoendosc Surg 19(3):e2015.00033CrossRefGoogle Scholar
  22. 22.
    Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211CrossRefPubMedGoogle Scholar
  23. 23.
    Sakpal SV, Bindra SS, Chamberlain RS (2010) Laparoscopic cholecystectomy conversion rates two decades later. J Soc Laparoendosc Surg 14:476–483CrossRefGoogle Scholar
  24. 24.
    Madureira FA, Manso JE, Madureira Fo D, Iglesias AC (2013) Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy. Surg Endosc 27:1009–1015CrossRefPubMedGoogle Scholar
  25. 25.
    Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y, Okuda J, Tanigawa N (2011) Impact of single-port cholecystectomy on postoperative pain. Br J Surg 98:991–995CrossRefPubMedGoogle Scholar
  26. 26.
    Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848CrossRefPubMedGoogle Scholar
  27. 27.
    Wong JS, Cheung YS, Fong KW, Chong CC, Lee KF, Wong J, Lai PB (2012) Comparison of postoperative pain between single-incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy: prospective case-control study. Surg Laparosc Endosc Percutan Tech 22:25–28CrossRefPubMedGoogle Scholar
  28. 28.
    Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, DeNoto G, Rivas H, Islam A, Soper N, Gecelter G, Rubach E, Paraskeva P, Shah S (2012) Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc 26:1296–1303CrossRefPubMedGoogle Scholar
  29. 29.
    Breivik H, Borchgrevink PC, Allen SM, Rosseland LA, Romundstad L, Hals EK, Kvarstein G, Stubhaug A (2008) Assessment of pain. Br J Anaesth 101:17–24CrossRefPubMedGoogle Scholar
  30. 30.
    Pisanu A, Reccia I, Porceddu G, Uccheddu A (2012) Meta-analysis of prospective randomized studies comparing single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC). J Gastrointest Surg 16:1790–1801CrossRefPubMedGoogle Scholar
  31. 31.
    Agaba EA, Rainville H, Ikedilo O, Vemulapali P (2014) Incidence of port-site incisional hernia after single-incision laparoscopic surgery. J Soc Laparoendosc Surg 18:204–210CrossRefGoogle Scholar
  32. 32.
    Alptekin H, Yilmaz H, Acar F, Kafali ME, Sahin M (2012) Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 22:731–737CrossRefPubMedGoogle Scholar
  33. 33.
    Bunting DM (2010) Port-site hernia following laparoscopic cholecystectomy. J Soc Laparoendosc Surg 14:490–497CrossRefGoogle Scholar
  34. 34.
    Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, DeNoto G, Gecelter G, Rubach E, Rivas H, Islam A, Soper N, Paraskeva P, Rosemurgy A, Ross S, Shah S (2013) Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg 216:1037–1047 (discussion 1047–1038) CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Banujan Balachandran
    • 1
  • Theadore A. Hufford
    • 2
  • Taha Mustafa
    • 1
  • Kunal Kochar
    • 1
  • Suela Sulo
    • 3
  • Joubin Khorsand
    • 4
  1. 1.Division of Colon and Rectal SurgeryAdvocate Lutheran General HospitalPark RidgeUSA
  2. 2.University of Illinois Metropolitan Group General Surgery ResidencyAdvocate Lutheran General HospitalPark RidgeUSA
  3. 3.Russell Institute for Research and InnovationAdvocate Lutheran General HospitalPark RidgeUSA
  4. 4.Division of General SurgeryAdvocate Lutheran General HospitalPark RidgeUSA

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