Surgical Endoscopy

, Volume 31, Issue 8, pp 3242–3250 | Cite as

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

  • Omar Yusef Kudsi
  • Andres Castellanos
  • Srinivas Kaza
  • Justin McCarty
  • Eugene Dickens
  • David Martin
  • Frederick M. Tiesenga
  • Konstantinos Konstantinidis
  • Petros Hirides
  • Shilpa Mehendale
  • Anthony Gonzalez



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. identifier NCT01932216.


Laparoscopy Robotic-assisted surgery Single-port cholecystectomy Multiport cholecystectomy Cosmesis Quality of life 



The authors would like to thank the following independent contributors: Mimi Wainwright (Wainwright Medical Communications, Los Gatos, CA USA) for editorial support and Vijaya Bharathi Lingala, Ph.D. (Institute of Clinical Outcomes Research and Education, Woodside CA and Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA USA) for her contribution toward the statistical study design and study data analysis.


This study was sponsored and funded by Intuitive Surgical, Inc., Sunnyvale, CA, USA in association with the identified study investigators under a cooperative clinical trial agreement. The authors had full control of the study execution, analysis, and development of the manuscript.

Compliance with ethical standards


All authors received research study support from Intuitive Surgical, statistical analysis from the Institute of Clinical Outcomes Research and Education, and editorial support from Wainwright Medical Communications. Dr. Kudsi has received honoraria and research study support outside the scope of this work. Dr. Kaza is a consultant for Intuitive. Dr. Dickens is a consultant for Intuitive and has received grants from Intuitive as well as speakers bureau fees and fees to develop educational presentations. Dr. Martin receives fees as a proctor for Intuitive. Ms. Mehendale is an employee of Intuitive. Dr. Gonzalez receives consultancy fees from Ethicon Endo Surgery, Mallinkrodt Pharmaceuticals, and Minimally Invasive Devices outside the scope of this work. Omar Yusef Kudsi, Andres Castellanos, Srinivas Kaza, Justin McCarty, Eugene Dickens, David Martin, Frederick M. Tiesenga, Konstantinos Konstantinidis, Petros Hirides, Shilpa Mehendale, and Anthony Gonzalez have no other conflicts of interest or financial ties to disclose.


  1. 1.
    Lytynski GS (1998) Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS 2:341–346Google Scholar
  2. 2.
    Vaughan J, Gurusamy KS, Davidson BR (2013) Day-surgery versus overnight stay surgery for laparoscopic cholecystectomy. Cochrane Database Syst Rev 31(7):CD006798. doi: 10.1002/14651858.CD006798.pub4 Google Scholar
  3. 3.
    Vidal O, Valentini M, Espert JJ, Ginesta C, Jimeno J, Martinez A, Benarroch G, Garcia-Valdecasas JC (2009) Laparoendoscopic single-site cholecystectomy: a safe and reproducible alternative. J Laparoendosc Adv Surg Tech A 19(5):599–602. doi: 10.1089/lap.2009.0205 CrossRefPubMedGoogle Scholar
  4. 4.
    Hodgett SE, Hernandez JM, Morton CA, Ross SB, Alvrink M, Rosemurgy AS (2009) Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg 13(2):188–192. doi: 10.1007/s11605-008-0735-0 CrossRefPubMedGoogle Scholar
  5. 5.
    Marks JM, Phillips MS, Tacchino R, Roberts K, Onders R, DeNoto G, Gecelter G, Rubach E, 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 versus single-incision laparoscopic cholecystectomy. J Am Coll Surg 216(6):1037–1047. doi: 10.1016/j.jamcollsurg.2013.02.024 (discussion 1047–1048) CrossRefPubMedGoogle Scholar
  6. 6.
    Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R, DeNoto 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(5):1296–1303. doi: 10.1007/s00464-011-2028-z CrossRefPubMedGoogle Scholar
  7. 7.
    Marks J, Tacchino R, Roberts K, Onders R, DeNoto G, Paraskeva P, Rivas H, Soper N, Rosemurgy A, Shah S (2011) Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single–incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 201(3):369–372. doi: 10.1016/j.amjsurg.2010.09.012 (discussion 372–373) CrossRefPubMedGoogle Scholar
  8. 8.
    Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA (1998) Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc 12(11):1334–1340CrossRefPubMedGoogle Scholar
  9. 9.
    Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P (2011) Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 98(12):1695–1702. doi: 10.1002/bjs.7689 CrossRefPubMedGoogle Scholar
  10. 10.
    Morel P, Hagen ME, Bucher P, Buchs NC, Pugin F (2011) Robotic single–port cholecystectomy using a new platform: initial clinical experience. J Gastrointest Surg 15(12):2182–2186. doi: 10.1007/s11605-011-1688-2 CrossRefPubMedGoogle Scholar
  11. 11.
    Buzad FA, Corne LM, Brown TC, Fagin RS, Hebert AE, Kaczmarek CA, Pack AN, Payne TN (2013) Single-site robotic cholecystectomy: efficiency and cost analysis. Int J Med Robot 9(3):365–370. doi: 10.1002/rcs.1507 CrossRefPubMedGoogle Scholar
  12. 12.
    Morel P, Pugin F, Bucher P, Buchs NC, Hagen ME (2012) Robotic single-incision laparoscopic cholecystectomy. J Robot Surg 6(3):273–274. doi: 10.1007/s11701-011-0310-7 CrossRefPubMedGoogle Scholar
  13. 13.
    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(8):709–714. doi: 10.1001/archsurg.2012.508 CrossRefPubMedGoogle Scholar
  14. 14.
    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(10):1122–1127. doi: 10.1001/archsurg.2011.143 CrossRefPubMedGoogle Scholar
  15. 15.
    Pietrabissa A, Pugliese L, Vinci A, Peri A, Tinozzi FP, Cavazzi E, Pellegrino E, Klersy C (2016) Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc. doi: 10.1007/s00464-015-4601-3 Google Scholar
  16. 16.
    Geng L, Sun C, Bai J (2013) Single incision versus conventional laparoscopic cholecystectomy outcomes: a meta-analysis of randomized controlled trials. PLoS One 8(10):e76530. doi: 10.1371/journal.pone.0076530 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Joseph S, Moore BT, Sorensen GB, Earley JW, Tang F, Jones P, Brown KM (2011) Single-incision laparoscopic cholecystectomy: a comparison with the gold standard. Surg Endosc 25(9):3008–3015. doi: 10.1007/s00464-011-1661-x CrossRefPubMedGoogle Scholar
  18. 18.
    Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK (2011) Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four–port laparoscopic cholecystectomy. Am J Surg 202(3):254–258. doi: 10.1016/j.amjsurg.2010.12.009 CrossRefPubMedGoogle Scholar
  19. 19.
    Trastulli S, Cirocchi R, Desiderio J, Guarino S, Santoro A, Parisi A, Noya G, Boselli C (2013) Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy. Br J Surg 100(2):191–208. doi: 10.1002/bjs.8937 CrossRefPubMedGoogle Scholar
  20. 20.
    Gonzalez A, Hernandez Murcia C, Romero R, Escobar E, Garcia P, Walker G, Gallas M, Dickens E, McIntosh B, Norwood W, Kim K, Rabaza J, Parris D (2016) A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases. Surg Endosc 30(7):2951–2960. doi: 10.1007/s00464-015-4583-1 CrossRefPubMedGoogle Scholar
  21. 21.
    Spinoglio G, Lenti LM, Maglione V, Lucido FS, Priora F, Bianchi PP, Grosso F, Quarati R (2012) Single–site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience. Surg Endosc 26(6):1648–1655. doi: 10.1007/s00464-011-2087-1 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Omar Yusef Kudsi
    • 1
    • 11
  • Andres Castellanos
    • 2
  • Srinivas Kaza
    • 3
  • Justin McCarty
    • 4
  • Eugene Dickens
    • 5
  • David Martin
    • 6
  • Frederick M. Tiesenga
    • 7
  • Konstantinos Konstantinidis
    • 8
  • Petros Hirides
    • 8
  • Shilpa Mehendale
    • 9
  • Anthony Gonzalez
    • 10
  1. 1.Tufts University School of MedicineBostonUSA
  2. 2.Drexel University College of MedicinePhiladelphiaUSA
  3. 3.JFK Medical CenterLake WorthUSA
  4. 4.St. Elizabeth’s Medical CenterTufts University School of MedicineBostonUSA
  5. 5.Hillcrest Medical CenterTulsaUSA
  6. 6.Huntington HospitalPasadenaUSA
  7. 7.West Suburban Medical CenterOak ParkUSA
  8. 8.Athens Medical CenterAthensGreece
  9. 9.Intuitive Surgical Clinical AffairsSunnyvaleUSA
  10. 10.Baptist Hospital South FloridaMiamiUSA
  11. 11.BrocktonUSA

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