Safety of single-incision robotic cholecystectomy for benign gallbladder disease: a systematic review
Multiport laparoscopic cholecystectomy (MLC) is the gold standard technique for cholecystectomy. In order to reduce postoperative pain and improve cosmetic results, the application of the single-incision laparoscopic cholecystectomy (SILC) technique was introduced, leading surgeons to face important challenges. Robotic technology has been proposed to overcome some of these limitations. The purpose of this review is to assess the safety of single-incision robotic cholecystectomy (SIRC) for benign disease.
An Embase and Pubmed literature search was performed in February 2017. Randomized controlled trial and prospective observational studies were selected and assessed using PRISMA recommendations. Primary outcome was overall postoperative complication rate. Secondary outcomes were postoperative bile leak rate, total conversion rate, operative time, wound complication rate, postoperative hospital stay, and port site hernia rate. The outcomes were analyzed in Forest plots based on fixed and random effects model. Heterogeneity was assessed using the I2 statistic.
A total of 13 studies provided data about 1010 patients who underwent to SIRC for benign disease of gallbladder. Overall postoperative complications rate was 11.6% but only 4/1010 (0.4%) patients required further surgery. A postoperative bile leak was reported in 3/950 patients (0.3%). Conversion occurred in 4.2% of patients. Mean operative time was 86.7 min including an average of 42 min should be added as for robotic console time. Wound complications occurred in 3.7% of patients. Median postoperative hospital stay was 1 day. Port site hernia at the latest follow-up available was reported in 5.2% of patients.
The use of the Da Vinci robot in single-port cholecystectomy seems to have similar results in terms of incidence and grade of complications compared to standard laparoscopy. In addition, it seems affected by the same limitations of single-port surgery, consisting of an increased operative time and incidence of port site hernia.
KeywordsRobotic cholecystectomy Single site Minimally invasive surgical procedures Systematic review
The authors declare that no funding support was received for this study.
Compliance with Ethical Standards
Drs Marco Migliore, Alberto Arezzo, Simone Arolfo, Roberto Passera, and Mario Morino have no conflicts of interest or financial ties to disclose.
- 5.Arezzo A, Passera R, Bullano A, Mintz Y, Kedar A, Boni L, Cassinotti E, Rosati R, Fumagalli Romario U, Sorrentino M, Brizzolari M, Di Lorenzo N, Gaspari AL, Andreone D, De Stefani E, Navarra G, Lazzara S, Degiuli M, Shishin K, Khatkov I, Kazakov I, Schrittwieser R, Carus T, Corradi A, Sitzman G, Lacy A, Uranues S, Szold A, Morino M (2017) Multi-port versus single-port cholecystectomy: results of a multi-centre, randomised controlled trial (MUSIC trial). Surg Endosc 31:2872–2880CrossRefGoogle Scholar
- 7.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 216:1037–1047CrossRefGoogle Scholar
- 10.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151:65–94CrossRefGoogle Scholar
- 11.Whiting P, Rutjes AW, Dinnes J, Reitsma J, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Methodol 10:3–25Google Scholar
- 12.Schwarzer G (2007) Meta: an R package for meta-analysis. R News 7:40–45Google Scholar
- 20.Kudsi OY, Castellanos A, Kaza S, McCarty J, Dickens E, Martin D, Tiesenga FM, Konstantinidis K, Hirides P, Mehendale S, Gonzalez A (2017) 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. Surg Endosc 3:3242–3250CrossRefGoogle Scholar
- 21.Lee H, Lee DH, Kim H, Han Y, Kim SW, Jang JY (2017) Single-incision robotic cholecystectomy: a special emphasis on utilization of transparent gloveports to overcome limitations of single-site port. Int J Med Robot 13:1–6Google Scholar
- 37.Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125Google Scholar
- 47.Arezzo A, Passera R, Forcignanò E, Rapetti L, Cirocchi R, Morino M (2018) Single-Incision laparoscopic cholecystectomy is responsible for increased adverse events: results of a meta-analysis of randomized controlled trials. Surg Endosc. https://doi.org/10.1007/s00464-018-6143-y CrossRefPubMedPubMedCentralGoogle Scholar
- 50.Zdichavsky M, Bashin YA, Blumenstock G, Zieker D, Meile T, Königsrainer A (2012) Impact of risk factors for prolonged operative time in laparoscopic cholecystectomy. J Gastroenterol Hepatol 24:1033–1038Google Scholar
- 51.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 26:1648–1655CrossRefGoogle Scholar
- 60.Zeng G, Teo NZ, Goh BKP (2018) Short-term outcomes of minimally invasive surgery for patients presenting with suspected gallbladder cancer: report of 8 cases. J Minim Access Surg 20:1–6Google Scholar