Robotic advance helps cholecystectomy surgeons
MedWire News: Advanced technology may widen the availability of single-site cholecystectomy, say Italian researchers who found that the technique can be learned within a day by experienced robotic surgeons.
"The robotic technology is a compensatory technique that can overcome the constraints and the ergonomic of SILS [single-incision laparoscopic cholecystercomy] and is potentially capable to realize the full potential of the single-access approach," say Andrea Pietrabissa (University of Pavia) and co-workers.
They report the outcome of the first 100 patients who underwent single-site cholecystectomy with the da Vinci Surgical System (Intuitive Surgical Inc, Sunnyvale, California, USA) by five surgeons at five Italian centers. The patients included 71 women, were aged a mean of 53.4 years, and had an average body mass index of 24.4 kg/m2.
Just two procedures were converted to open surgery due to unforeseen chronic hilum inflammation. Minor complications included seven gallbladder ruptures, and five cases of minor bleeding from the gallbladder bed.
The procedures took a median of 71 minutes to perform, and procedure time did not decline significantly with increasing surgeon experience.
Surgeons reported by questionnaire that the technique was more difficult than standard four-port laparoscopy, with specific difficulties noted with positioning the port, and tearing of the internal silicon edge.
However, the robotic procedure was judged easier to perform than SIL, and thought to have a better cosmetic outcome for the patient. Surgeons had mixed opinions on whether the robotic procedure would affect patient pain levels.
Noting that stepwise training took just 1 day for the experienced robotic surgeons, the team comments: "We showed that it allows the quick overcoming of the learning curve that is typical of most new procedures, particularly of the laparoscopic single-incision approach.
"This is likely to increase the safety of SILS and, in turn, expand its adoption to a wider number of general surgeons and surgical procedures."
Further research is required to demonstrate whether the technique is safer than conventional SILS, the researchers conclude.
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By Lynda Williams