Journal of Minimally Invasive Surgery

The Korean Society of Endoscopic & Laparoscopic Surgeons (대한내시경복강경외과학회)
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Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon's Workload

  • Kim, Hyeong Seok (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Han, Youngmin (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Kang, Jae Seung (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Lee, Doo-ho (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Kim, Jae Ri (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Kwon, Wooil (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Kim, Sun-Whe (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine) ;
  • Jang, Jin-Young (Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine)
  • Received : 2018.07.02
  • Accepted : 2018.08.24
  • Published : 2018.12.15
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Abstract

Purpose: Robotic-associated minimally invasive surgery is a novel method for overcoming some limitations of laparoscopic surgery. This study aimed to evaluate the outcomes (postoperative pain, cosmesis, surgeon's workload) of single-incision robotic cholecystectomy (SIRC) vs. single-incision laparoscopic cholecystectomy (SILC) vs. conventional three-port laparoscopic cholecystectomy (3PLC). Methods: 134 patients who underwent laparoscopic or robotic cholecystectomy at a single center during 2016~2017 were enrolled. Prospectively collected data included demographics, operative outcomes, questionnaire regarding pain and cosmesis, and NASA-Task Load Index (NASA-TLX) scores for surgeon's workload. Results: 55 patients underwent SIRC, 29 SILC, and 50 3PLC during the same period. 3PLC patient group was older than the others (SIRC vs. SILC vs. 3PLC: 48.1 vs. 42.2 vs. 54.1 years, p<0.001). Operative time was shortest with 3PLC (44.1 vs. 38.8 vs. 25.4 min, p<0.001). Estimated blood loss, postoperative complications, and postoperative stay were similar among the groups. Pain control was lowest in the 3PLC group (98.2% vs. 100% vs. 84.0%, p=0.004), however, at 2 weeks postoperatively there were no differences among the groups (p=0.374). Cosmesis scores were also worst after 3PLC (17.5 vs. 18.4 vs. 13.3, p<0.001). NASA-TLX score was highest in the SILC group (21.9 vs. 44.3 vs. 25.2, p<0.001). Conclusion: Although SIRC and SILC take longer than 3PLC, they produce superior cosmetic outcomes. Compared with SILC, SIRC is more ergonomic, lowering the surgeon's workload. Despite of higher cost, SIRC could be an alternative for treating gallbladder disease in selected patients.

Keywords

References

  1. Begos DG, Modlin IM. Laparoscopic cholecystectomy: from gimmick to gold standard. J Clin Gastroenterol 1994;19:325-330. https://doi.org/10.1097/00004836-199412000-00015
  2. Frutos MD, Abrisqueta J, Lujan J, Abellan I, Parrilla P. Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg 2013;257:413-418. https://doi.org/10.1097/SLA.0b013e318278d225
  3. Hirano Y, Hattori M, Douden K, Ishiyama Y, Hashizume Y. Single-incision laparoscopic surgery for colorectal cancer. World J Gastrointest Surg 2016;8:95-100. https://doi.org/10.4240/wjgs.v8.i1.95
  4. Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T. Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc 2011;25:2400-2404. https://doi.org/10.1007/s00464-010-1563-3
  5. Lurje G, Raptis DA, Steinemann DC, et al. Cosmesis and Body Image in Patients Undergoing Single-port Versus Conventional Laparoscopic Cholecystectomy: A Multicenter Doubleblinded Randomized Controlled Trial (SPOCC-trial). Ann Surg 2015;262:728-734; discussion 734-725. https://doi.org/10.1097/SLA.0000000000001474
  6. Jorgensen LN, Rosenberg J, Al-Tayar H, Assaadzadeh S, Helgstrand F, Bisgaard T. Randomized clinical trial of singleversus multi-incision laparoscopic cholecystectomy. Br J Surg 2014;101:347-355. https://doi.org/10.1002/bjs.9393
  7. Qiu J, Yuan H, Chen S, He Z, Han P, Wu H. Single-port versus conventional multiport laparoscopic cholecystectomy: a metaanalysis of randomized controlled trials and nonrandomized studies. J Laparoendosc Adv Surg Tech A 2013;23:815-831. https://doi.org/10.1089/lap.2013.0040
  8. Scerbo MW, Britt RC, Stefanidis D. Differences in mental workload between traditional and single-incision laparoscopic procedures measured with a secondary task. Am J Surg 2017;213:244-248. https://doi.org/10.1016/j.amjsurg.2016.09.056
  9. Lee H, Lee DH, Kim H, Han Y, Kim SW, Jang JY. Single-incision robotic cholecystectomy: A special emphasis on utilization of transparent glove ports to overcome limitations of single-site port. Int J Med Robot 2017;13.
  10. Hartrick CT, Kovan JP, Shapiro S. The numeric rating scale for clinical pain measurement: a ratio measure? Pain Pract 2003;3:310-316. https://doi.org/10.1111/j.1530-7085.2003.03034.x
  11. Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA. Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn's disease. Surg Endosc 1998;12:1334-1340. https://doi.org/10.1007/s004649900851
  12. Hart SG, Staveland LE. Development of NASA-TLX (Task Load Index): Results of empirical and theoretical research. In: Hancock PA, Meshkati N, editors. Human mental workload. Amsterdam: Elsevier; 1988.
  13. Yurko YY, Scerbo MW, Prabhu AS, Acker CE, Stefanidis D. Higher mental workload is associated with poorer laparoscopic performance as measured by the NASA-TLX tool. Simul Healthc 2010;5:267-271. https://doi.org/10.1097/SIH.0b013e3181e3f329
  14. Stefanidis D, Wang F, Korndorffer JR, Jr., Dunne JB, Scott DJ. Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload. Surg Endosc 2010;24:377-382. https://doi.org/10.1007/s00464-009-0578-0
  15. Dulan G, Rege RV, Hogg DC, et al. Proficiency-based training for robotic surgery: construct validity, workload, and expert levels for nine inanimate exercises. Surg Endosc 2012;26:1516-1521. https://doi.org/10.1007/s00464-011-2102-6
  16. Gonzalez A, Murcia CH, Romero R, et al. A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases. Surg Endosc 2016;30:2951-2960. https://doi.org/10.1007/s00464-015-4583-1
  17. Strosberg DS, Nguyen MC, Muscarella P, 2nd, Narula VK. A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis. Surg Endosc 2017;31:1436-1441. https://doi.org/10.1007/s00464-016-5134-0
  18. Gustafson M, Lescouflair T, Kimball R, Daoud I. A comparison of robotic single-incision and traditional single-incision laparoscopic cholecystectomy. Surg Endosc 2016;30:2276-2280. https://doi.org/10.1007/s00464-015-4223-9
  19. Sodergren MH, Aslanyan A, McGregor CG, et al. Pain, wellbeing, body image and cosmesis: a comparison of single-port and four-port laparoscopic cholecystectomy. Minim Invasive Ther Allied Technol 2014;23:223-229. https://doi.org/10.3109/13645706.2014.886594
  20. Asakuma M, Hayashi M, Komeda K, et al. Impact of single-port cholecystectomy on postoperative pain. Br J Surg 2011;98:991-995. https://doi.org/10.1002/bjs.7486
  21. Phillips MS, Marks JM, Roberts K, et al. Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc 2012;26:1296-1303. https://doi.org/10.1007/s00464-011-2028-z
  22. Balachandran B, Hufford TA, Mustafa T, Kochar K, Sulo S, Kh-or sand J. A Comparative Study of Outcomes Between Single-Site Robotic and Multi-port Laparoscopic Cholecystectomy: An Experience from a Tertiary Care Center. World J Surg 2017;41:1246-1253. https://doi.org/10.1007/s00268-016-3799-0
  23. Kudsi OY, Castellanos A, Kaza S, et al. 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 2017;31:3242-3250. https://doi.org/10.1007/s00464-016-5353-4
  24. Marks JM, Phillips MS, Tacchino R, et al. 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 2013;216:1037-1047; discussion 1047-1038. https://doi.org/10.1016/j.jamcollsurg.2013.02.024
  25. Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg 2011;202:254-258. https://doi.org/10.1016/j.amjsurg.2010.12.009
  26. Ruiz-Rabelo JF, Navarro-Rodriguez E, Di-Stasi LL, et al. Validation of the NASA-TLX Score in Ongoing Assessment of Mental Workload During a Laparoscopic Learning Curve in Bariatric Surgery. Obes Surg 2015;25:2451-2456. https://doi.org/10.1007/s11695-015-1922-1
  27. Montero PN, Acker CE, Heniford BT, Stefanidis D. Single incision laparoscopic surgery (SILS) is associated with poorer performance and increased surgeon workload compared with standard laparoscopy. Am Surg 2011;77:73-77.
  28. Abdelrahman AM, Bingener J, Yu D, et al. Impact of singleincision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial. Surg Endosc 2016;30:1205-1211. https://doi.org/10.1007/s00464-015-4332-5
  29. Sarli L, Iusco D, Gobbi S, Porrini C, Ferro M, Roncoroni L. Randomized clinical trial of laparoscopic cholecystectomy performed with mini-instruments. Br J Surg 2003;90:1345-1348. https://doi.org/10.1002/bjs.4315
  30. Novitsky YW, Kercher KW, Czerniach DR, et al. Advantages of mini-laparoscopic vs conventional laparoscopic cholecystectomy: results of a prospective randomized trial. Arch Surg 2005;140:1178-1183. https://doi.org/10.1001/archsurg.140.12.1178
  31. Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J. Microlaparoscopic vs conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial. Surg Endosc 2002;16:458-464. https://doi.org/10.1007/s00464-001-9026-5
  32. Jeong JY, M.d, Choi EH, et al. Early Experience of Single Port Laparoscopic Cholecystectomy & Comparisons of Single Port and Three Port Laparoscopic Cholecystectomy. J Minim Invasive Surg 2010;13:17-21.

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