Single-site robotic-assisted laparoscopic cholecystectomy in children and adolescents: a report of 20 cases
Single-site laparoscopy is increasingly popular for straightforward operations like appendectomy. Due to limited triangulation and maneuverability, single-site cholecystectomy is riskier and more difficult. Robotics offer to make it easier and safer.
Twenty children and adolescents underwent robotic-assisted single-site cholecystectomy at a large academic children’s hospital. Patients were not randomized; patients were offered the option of robotic-assisted single-site (SSR) or standard four-incision laparoscopic (LAP) cholecystectomy. Demographics and perioperative details were compared with those of a comparable cohort who underwent LAP during the same period.
The two groups were similar in physical characteristics and indications for operation. The robotic operations took longer but both groups received similar PRN doses of parenteral opiates. Patients in the SSR group were all discharged on the first postoperative day. There were no major complications in either group but a slightly higher incidence of minor wound complications in the SSR group.
Robotic-assisted single-site cholecystectomy appears to be a safe alternative to standard laparoscopy with a similar postoperative pain profile, short postoperative lengths of stay, and, for some, a superior cosmetic result. Nevertheless, it comes with longer set-up and operative times, a higher incidence of minor wound complications, an unknown but possibly higher risk of incisional hernia, and higher costs.
KeywordsRobotic surgery Single-site surgery Cholecystectomy Minimally-invasive surgery Laparoscopic cholecystectomy Biliary dyskinesia
Compliance with ethical standards
Dr. Mattei has no conflicts of interest or financial ties to disclose.
- 4.Seims AD, Nice TR, Mortellaro VE, Lacher M, Ba’Ath ME, Anderson SA, Beierle EA, Martin CA, Rogers DA, Harmon CM, Chen MK, Russell RT (2015) Routine utilization of single-incision pediatric endosurgery (SIPES): a 5-year institutional experience. J Laparoendosc Adv Surg Tech A 25(3):252–255CrossRefPubMedGoogle Scholar
- 8.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):1648–1655CrossRefPubMedGoogle Scholar
- 10.Kudsi OY, Castellanos A, Kaza S, McCarty J, Dickens E, Martin D, Tiesenga FM, Konstantinidis K, Hirides P, Mehendale S, Gonzalez A (2016) 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. https://doi.org/10.1007/s00464-016-5353-4 Google Scholar
- 17.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(6):1037–1047CrossRefPubMedGoogle Scholar