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Ansari U, Syed B, Sedighi R, Ansari K, Akhtar M, Davies Y. Advancing Robotic Single-Site Cholecystectomy: Innovations, Challenges, and Future Directions. Cureus 2024; 16:e60643. [PMID: 38899255 PMCID: PMC11185930 DOI: 10.7759/cureus.60643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The crystalization of the components of bile within the gallbladder can lead to the formation of gallstones (cholelithiasis), which may often require surgical removal of the gallbladder, a procedure known as cholecystectomy, in symptomatic cases. Robotic single-site cholecystectomy (RSSC) is a recently introduced groundbreaking minimally invasive procedure for gallbladder removal. RSSC utilizes robotic technology, offering enhanced dexterity through a single-incision approach, promising improved outcomes such as reduced postoperative pain and superior cosmesis. However, certain limitations, such as restricted instrument movement and heightened hernia risk, necessitate a critical evaluation of this modality. Furthermore, as the widespread adoption of RSSC remains undecided due to concerns over its costs, efficiency, and overall superiority over prior models, this paper assesses future possibilities for RSSC's evolution. In vivo robotics, improved digital imaging, and re-engineering of the surgical instruments themselves are all potential avenues to augment the current RSSC design, although it is currently unclear as to what extent they could impact the procedure's viability. This review critically examines the available literature on the effectiveness and potency of RSSC compared to its predecessors in the modern healthcare setting and proposes future directions through which innovation could more firmly establish the procedure as the standard of care for cholecystectomy.
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Affiliation(s)
- Ubaid Ansari
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Burhaan Syed
- Radiology, California Northstate University College of Medicine, Elk Grove, USA
| | - Romteen Sedighi
- Internal Medicine, California Northstate University College of Medicine, Elk Grove, USA
| | | | - Muzammil Akhtar
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Yinka Davies
- Gastroenterology, California Northstate University College of Medicine, Elk Grove, USA
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Bosi HR, Rombaldi MC, Zaniratti T, Castilhos FO, Sbaraini M, Grossi JV, Pretto GG, Cavazzola LT. Does single‐site robotic surgery makes sense for gallbladder surgery? Int J Med Robot 2022; 18:e2363. [DOI: 10.1002/rcs.2363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/13/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Henrique Rasia Bosi
- Department of Surgery Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
| | | | - Thamyres Zaniratti
- Faculdade de Medicina Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | | | - Mariana Sbaraini
- Faculdade de Medicina Universidade Federal do Rio Grande do Sul Porto Alegre Brazil
| | | | - Guilherme Gonçalves Pretto
- Department of Surgery Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Department of Surgery Hospital Moinhos de Vento Porto Alegre Brazil
| | - Leandro Totti Cavazzola
- Department of Surgery Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
- Department of Surgery Hospital Moinhos de Vento Porto Alegre Brazil
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Wang Y, Cao D, Chen SL, Li YM, Zheng YW, Ohkohchi N. Current trends in three-dimensional visualization and real-time navigation as well as robot-assisted technologies in hepatobiliary surgery. World J Gastrointest Surg 2021; 13:904-922. [PMID: 34621469 PMCID: PMC8462083 DOI: 10.4240/wjgs.v13.i9.904] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/19/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
With the continuous development of digital medicine, minimally invasive precision and safety have become the primary development trends in hepatobiliary surgery. Due to the specificity and complexity of hepatobiliary surgery, traditional preoperative imaging techniques such as computed tomography and magnetic resonance imaging cannot meet the need for identification of fine anatomical regions. Imaging-based three-dimensional (3D) reconstruction, virtual simulation of surgery and 3D printing optimize the surgical plan through preoperative assessment, improving the controllability and safety of intraoperative operations, and in difficult-to-reach areas of the posterior and superior liver, assistive robots reproduce the surgeon’s natural movements with stable cameras, reducing natural vibrations. Electromagnetic navigation in abdominal surgery solves the problem of conventional surgery still relying on direct visual observation or preoperative image assessment. We summarize and compare these recent trends in digital medical solutions for the future development and refinement of digital medicine in hepatobiliary surgery.
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Affiliation(s)
- Yun Wang
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Di Cao
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Si-Lin Chen
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yu-Mei Li
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yun-Wen Zheng
- Institute of Regenerative Medicine, and Affiliated Hospital of Jiangsu University, Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
- Guangdong Provincial Key Laboratory of Large Animal Models for Biomedicine, and School of Biotechnology and Heath Sciences, Wuyi University, Jiangmen 529020, Guangdong Province, China
- School of Medicine, Yokohama City University, Yokohama 234-0006, Kanagawa, Japan
| | - Nobuhiro Ohkohchi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Ibaraki, Japan
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Beltzer C, Gradinger K, Bachmann R, Axt S, Dippel H, Schmidt R. Robotic multiport versus robotic single-site cholecystectomy: a retrospective single-centre experience of 142 cases. Eur Surg 2020. [DOI: 10.1007/s10353-019-00619-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Gonzalez-Ciccarelli LF, Quadri P, Daskalaki D, Milone L, Gangemi A, Giulianotti PC. [Robotic approach to hepatobiliary surgery. German version]. Chirurg 2018; 88:19-28. [PMID: 27470057 DOI: 10.1007/s00104-016-0223-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Robot-assisted hepatobiliary surgery has been steadily growing in recent years. It represents an alternative to the open and laparoscopic approaches in selected patients. Endowristed instruments and enhanced visualization provide important advantages in terms of selective bleeding control, microsuturing, and dissection. Cholecystectomies and minor hepatectomies are being performed with comparable results to open and laparoscopic surgery. Even complex procedures, such as major and extended hepatectomies, can have excellent outcomes, in expert hands. The addition of indocyanine green fluorescence provides an additional advantage for recognition of the vascular and biliary anatomy. Future innovations will allow for expanding its use and indications. Robotic surgery has become a very important component of modern minimally invasive surgery and the development of new robotic technology will facilitate a broader adoption of this technique.
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Affiliation(s)
- L F Gonzalez-Ciccarelli
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA
| | - P Quadri
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA
| | - D Daskalaki
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA
| | - L Milone
- Brooklyn Hospital Center, Brooklyn, NY, USA
| | - A Gangemi
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA
| | - P C Giulianotti
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois Hospital and Health Sciences System, 840 S Wood St, 60612, Chicago, IL, USA.
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Abaid RA, Zilberstein B. Two-Incision Laparoscopic Cholecystectomy: Reducing Scars in a Simple Way. J Laparoendosc Adv Surg Tech A 2017; 28:7-12. [PMID: 28514179 DOI: 10.1089/lap.2017.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND About 20% of the population has cholelithiasis and this is the main abdominal cause of hospitalization in developed countries. Considering that only in the United States about 700,000 cholecystectomies are done each year, it is possible to estimate the importance of the problem for public health. OBJECTIVE To describe a two-incision laparoscopic cholecystectomy (TILC) technique using only conventional material, without increasing complications or operative time. MATERIALS AND METHODS A consecutive and prospective case series compared to another historical operated by conventional laparoscopic cholecystectomy (LC). The TILC was performed with three trocars in two incisions, two trocars in umbilical incision, and one in epigastrium. RESULTS A total of 72 patients were operated on by the same surgeon (36 in each group). There were no significant differences between groups for gender, mean age, body mass index, or length of hospital stay. The procedures were classified by the surgeon according to surgical difficulty and 58.3% (n = 42) were considered low grade, 9.7% (n = 7) difficult, and the other were intermediaries, with no difference between the series (P < .05). There were minor complications in 6.94% (n = 5) procedures. There were no differences between mean operative time (P = .989), which was 49 (95% confidence interval [CI] 42-56) minutes in LC and 40 (95% CI 35-44) min in TILC. There was no need for additional trocars in any case or for conversion to open surgery. CONCLUSIONS TILC is feasible, safe, and with good aesthetic result, using the same instruments of LC, without increasing operative time.
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Affiliation(s)
- Rafael Antoniazzi Abaid
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine , Sao Paulo, Brazil
| | - Bruno Zilberstein
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine , Sao Paulo, Brazil
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Robotic single-site plus ONE port distal pancreatectomy. Surg Endosc 2017; 31:4258-4259. [DOI: 10.1007/s00464-017-5476-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/15/2017] [Indexed: 02/06/2023]
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Fransen SA, van den Bos J, Stassen LP, Bouvy ND. Is Single-Port Laparoscopy More Precise and Faster with the Robot? J Laparoendosc Adv Surg Tech A 2016; 26:898-904. [DOI: 10.1089/lap.2016.0350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sofie A.F. Fransen
- Department of Surgery, Laurentius Ziekenhuis Roermond, Roermond, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jacqueline van den Bos
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laurents P.S. Stassen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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van der Linden YTK, Brenkman HJF, van der Horst S, van Grevenstein WMU, van Hillegersberg R, Ruurda JP. Robotic Single-Port Laparoscopic Cholecystectomy Is Safe but Faces Technical Challenges. J Laparoendosc Adv Surg Tech A 2016; 26:857-861. [PMID: 27258800 DOI: 10.1089/lap.2016.0183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND For cholecystectomy, multiport laparoscopy is the recommended surgical approach. Single-port laparoscopy (SPL) was introduced to reduce postoperative pain and provide better cosmetic results, but has technical disadvantages. Robotic SPL (RSPL) was developed to overcome these disadvantages. In this prospective study, we aim to describe intraoperative results and postoperative outcomes of RSPL cholecystectomies and evaluate technical aspects of the technique. METHODS A prospective database of all patients who underwent a RSPL cholecystectomy between January 2012 and December 2014 was analyzed. Intraoperative results and postoperative complications were evaluated. RESULTS A total of 27 patients underwent RSPL cholecystectomy. Median age was 59 (20-78) years and median body mass index was 25 (19-35) kg/m2. The majority of patients had American Society of Anesthesiologists (ASA) II classification (67%) and 89% underwent surgery for cholecystolithiasis or cholecystitis. The median operating time was 81 (41-115) minutes. Conversion to a multiport procedure occurred in 2; one due to insufficient length of the robotic instruments. In the second and third patients, conversion to an open procedure was necessary due to inadequate exposure caused by liver cirrhosis and purulent ascites, respectively. In seven procedures, spill occurred due to rupture of the gallbladder. Postoperative complications occurred in 4 patients, including 1 bleeding (no reintervention), 1 peritonitis, and 2 wound infections. After a median follow-up of 33 (10-44) months, 5 (19%) trocar-site hernias were seen. CONCLUSION RSPL cholecystectomy is feasible, however, encountered by technical challenges due to inadequate length of the nonwristed robotic instruments. A high incidence of gallbladder rupture and trocar-site hernias may limit its application.
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Affiliation(s)
| | - Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Sylvia van der Horst
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
| | | | | | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
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Kubat E, Hansen N, Nguyen H, Wren SM, Eisenberg D. Urgent and Elective Robotic Single-Site Cholecystectomy: Analysis and Learning Curve of 150 Consecutive Cases. J Laparoendosc Adv Surg Tech A 2016; 26:185-91. [PMID: 26756715 DOI: 10.1089/lap.2015.0528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The use of robotic single-site cholecystectomy has increased exponentially. There are few reports describing the safety, efficacy, and operative learning curve of robotic single-site cholecystectomy either in the community setting or with nonelective surgery. MATERIALS AND METHODS We performed a retrospective review of a prospective database of our initial experience with robotic single-site cholecystectomy. Demographics and perioperative outcomes were evaluated for both urgent and elective cholecystectomy. Cumulative sum analysis was performed to determine the surgeon's learning curve. RESULTS One hundred fifty patients underwent robotic single-site cholecystectomy. Seventy-four (49.3%) patients underwent urgent robotic single-site cholecystectomy, and 76 (50.7%) underwent elective robotic single-site cholecystectomy. Mean total operative time for robotic single-site cholecystectomy was 83.3 ± 2.7 minutes. Mean operative time for the urgent cohort was significantly longer than for the elective cohort (95.0 ± 4.4 versus 71.9 ± 2.6 minutes; P < .001). There was one conversion in the urgent cohort and none in the elective cohort. There was one bile duct injury (0.7%) in the urgent cohort. Perioperative complications occurred in 8.7% of patients, and most consisted of superficial surgical-site infections. There were no incisional hernias detected. The surgeon's learning curve, inclusive of urgent and elective cases, was 48 operations. CONCLUSIONS Robotic single-site cholecystectomy can be performed safely and effectively in both elective and urgent cholecystectomy with a reasonable learning curve and acceptable perioperative outcomes.
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Affiliation(s)
- Eric Kubat
- 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California
| | - Nathan Hansen
- 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California
| | - Huy Nguyen
- 2 Department of Surgery, Regional Medical Center , San Jose, California
| | - Sherry M Wren
- 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California
| | - Dan Eisenberg
- 1 Department of Surgery, Stanford University School of Medicine and VA Palo Alto Health Care System , Palo Alto, California
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