Single-Site Robotic Cholecystectomy: Reverse-Port Technique |
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Authors: | Myung Jae Jung So young Lee Sung Hwan Lee Chang Moo Kang Woo Jung Lee |
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Institution: | From the Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine (SYL, SHL, CMK, WJL); Department of Critical Care and Trauma Surgery, Yonsei University College of Medicine (MJJ); and Pancreaticobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Severance Hospital, Seoul, Korea (SYL, SHL, CMK, WJL). |
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Abstract: | This study aims to introduce an alternative technique for effective single-site robotic cholecystectomy (SSRC) using a reverse port.Proper exposure of Calot''s triangle is critical for safe laparoscopic cholecystectomy. Current robotic surgical systems are useful for single-site cholecystectomy. However, in exposing Calot''s triangle, the gallbladder is usually retracted in a medial and upward direction, resulting in a narrow triangle. This intraoperative view is a major obstacle to safe laparoscopic cholecystectomy.From October 2013 to October 2014, 55 consecutive patients underwent SSRC by a single surgeon at Yonsei University Severance Hospital. Initially, 5 patients underwent the original robotic single site cholecystectomy technique, and the remaining 50 patients underwent robotic single site cholecystectomy using our reverse port technique.There were no differences between the SSRC-O (original port) group and the SSRC-R (reverse port) group in terms of patient age (P = 0.244), body mass index (P = 0.503), and pathologic conditions of the gallbladder (P = 0.841). Total operation time (132.6 vs 99.12 min; P = 0.009), actual dissection time (51.6 vs 30.28 min; P = 0.001), and console time (84.4 vs 50.46 min; P = 0.001) were all significantly shorter in the SSRC-R group. Mean intraoperative blood loss was minimal in both groups (20 vs 12.4 mL, P = 0.467), and bile spillage occurred in 2 patients of the SSRC-R group. There was one case of laparoscopic conversion in the SSRC-R group.The reverse port technique described in this study successfully widened Calot''s triangle and improved the safety of the current robotic surgical system for single-site robotic cholecystectomy. |
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