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Single-incision cholecystectomy: a comparative study of standard laparoscopic, robotic, and SPIDER platforms

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Abstract

Background

Many series have shown the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC), but this technique still has limitations such as instrument collisions and lack of triangulation. Recently, two single-incision platforms, robotic and SPIDER, have attempted to ameliorate such problems. This study aimed to compare three different techniques of single-incision cholecystectomy: standard laparoscopic, robotic, and SPIDER approaches.

Methods

The authors retrospectively collected data from their first 166 single-incision robotic cholecystectomies (SIRCs) and compared the findings with the data from their first 166 SILCs and the first 166 s-generation SPIDER procedures. All the SILCs were performed with three trocars placed in one umbilical incision and with gallbladder retraction using a Prolene stitch on the right upper quadrant. All the robotic cases were managed using the da Vinci Single-Site Surgical System, and all the SPIDER procedures were performed using the SPIDER Surgical System.

Results

The SILC, SIRC, and SPIDER groups consisted respectively of 129 (76.3 %), 131 (78.9 %), and 136 (81.9 %) women with the respective mean ages of 44.5 ± 14.3, 51.6 ± 15.9, and 46.4 ± 15.2 years. The mean body mass indexes (BMIs) were respectively 29.1 ± 5.6, 29.4 ± 6.2, and 27.5 ± 4.8 kg/m2, and the mean surgical times were 37.1 ± 13.3, 63.0 ± 25.2, and 52.8 ± 18.7 min. The total hospital stays were respectively 1.3 ± 5.3, 1.2 ± 2.2, and 1.5 ± 2.6 days, and complications were seen respectively in three SILC cases (1.8 %), three SIRC cases (1.8 %), and two SPIDER cases (1.2 %).

Conclusions

The results of this study demonstrate similar results among the three platforms for most of the parameters measured. The SILC procedure appears to be superior to SIRC and SPIDER in terms of surgical time, but selection bias could be the cause. The SILS, SIRC, and SPIDER procedures all are similar in terms of complication profile. It can be concluded that SILC, SIRC, and SPIDER all are feasible and safe alternatives when used for single-incision cholecystectomy.

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Acknowledgments

We would like to acknowledge Francia Cordero for her work in logistics and coordination of the research team as well as coordinating patient surgeries and interviews.

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Authors and Affiliations

  1. Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA

    Anthony Michael Gonzalez, Jorge Rafael Rabaza, Charan Donkor, Rey Jesús Romero & Radomir Kosanovic

  2. Department of General and Bariatric Surgery, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA

    Anthony Michael Gonzalez, Jorge Rafael Rabaza & Juan Carlos Verdeja

  3. 7800 SW 87 Ave, Suite B-210, Miami, FL, 33173, USA

    Anthony Michael Gonzalez

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  1. Anthony Michael Gonzalez
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  2. Jorge Rafael Rabaza
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Correspondence to Anthony Michael Gonzalez.

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Gonzalez, A.M., Rabaza, J.R., Donkor, C. et al. Single-incision cholecystectomy: a comparative study of standard laparoscopic, robotic, and SPIDER platforms. Surg Endosc 27, 4524–4531 (2013). https://doi.org/10.1007/s00464-013-3105-2

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