Intraoperative and postoperative outcomes of robot-assisted cholecystectomy: a systematic review

Abstract Background Rapid adoption of robotic-assisted general surgery procedures, particularly for cholecystectomy, continues while questions remain about its benefits and utility. The objective of this study was to compare the clinical effectiveness of robot-assisted cholecystectomy for benign gallbladder disease as compared with the laparoscopic approach. Methods A literature search was performed from January 2010 to March 2020, and a narrative analysis was performed as studies were heterogeneous. Results Of 887 articles screened, 44 met the inclusion criteria (range 20–735,537 patients). Four were randomized controlled trials, and four used propensity-matching. There were variable comparisons between operative techniques with only 19 out of 44 studies comparing techniques using the same number of ports. Operating room time was longer for the robot-assisted technique in the majority of studies (range 11–55 min for 22 studies, p < 0.05; 15 studies showed no difference; two studies showed shorter laparoscopic times), while conversion rates and intraoperative complications were not different. No differences were detected for the length of stay, surgical site infection, or readmissions. Across studies comparing single-port robot-assisted to multi-port laparoscopic cholecystectomy, there was a higher rate of incisional hernia; however, no differences were noted when comparing single-port robot-assisted to single-port laparoscopic cholecystectomy. Conclusions Clinical outcomes were similar for benign, elective gallbladder disease for robot-assisted compared with laparoscopic cholecystectomy. Overall, the rates of complications were low. More high-quality studies are needed as the robot-assisted technique expands to more complex gallbladder disease, where its utility may prove increasingly beneficial. Systematic review registration PROSPERO CRD42020156945

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Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis

Surgical Endoscopy ◽

10.1007/s00464-021-08677-7 ◽

2021 ◽

Author(s):

N. Aruparayil ◽

W. Bolton ◽

A. Mishra ◽

L. Bains ◽

J. Gnanaraj ◽

...

Keyword(s):

Systematic Review ◽

General Surgery ◽

Open Surgery ◽

Meta Analysis ◽

Intraoperative Complications ◽

Clinical Effectiveness ◽

Conventional Laparoscopy ◽

Gynaecological Surgery ◽

Gasless Laparoscopy ◽

Conversion Rates

Abstract Background In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures. Methods A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. Secondary outcomes: operative times and length of stay. The inverse variance random-effects model was used to synthesise data. Results 63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45–2.40] or gynaecological surgery RR 0.66 [0.14–3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26–60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD − 18.74 [CI − 29.23, − 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD − 3.94 [CI − 5.93, − 1.95] and gynaecology MD − 1.75 [CI − 2.64, − 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low. Conclusion Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.

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Complications of robot-assisted and laparoscopic partial nephrectomy

Cancer Urology ◽

10.17650/1726-9776-2021-17-2-34-45 ◽

2021 ◽

Vol 17 (2) ◽

pp. 34-45

Author(s):

S. A. Rakul ◽

K. V. Pozdnyakov ◽

R. A. Eloev

Keyword(s):

Postoperative Complications ◽

Blood Transfusion ◽

Partial Nephrectomy ◽

Intraoperative Complications ◽

Laparoscopic Approach ◽

High Complexity ◽

Robot Assisted ◽

Kidney Tumors ◽

Intraoperative Complication ◽

Grade Ii

Objective: to analyze complications after laparoscopic and robotic-assisted partial nephrectomy.Materials and methods. In our study was included 246 cases. Intra- and postoperative complications were studied after nephron-sparring surgery. The laparoscopic approach was used in 68 (27.3 %) cases, the robot-assisted - in 178 (71.5 %) cases. Intraoperative complications were assessed according to the Rosenthal classification, postoperative complications - according to the Clavien-Dindo classification.Results. The overall incidence of intraoperative complications was 12.6 %. The most frequent intraoperative complication was bleeding that did not require blood transfusion (grade I) - 5.69 % (laparoscopic approach - in 3 (4.41 %) cases, robot-assisted approach - in 11 (6,18 %) cases). Bleeding requiring blood transfusion and injuries of internal organs, which were restored intraoperatively (grade II), were recorded in laparoscopic and robot-assisted approaches in 4.41 % and 2.25 % of cases, respectively. Complications leading to the loss of organ (nephrectomy, splenectomy) were observed in 2.94 % and 4.49 % of cases, respectively. Intraoperative deaths (grade IV) were not registered.The incidence of postoperative complications was 18.29 %. Minor complications (Clavien-Dindo ≤II) were detected in 16 (6.5 %) patients (laparoscopic approach - 7.35 %, robot-assisted approach - 6.18 %). Serious complications (Clavien-Dindo ≥III) were detected in 29 (11.79 %) cases (with laparoscopic approach - 14.71 %, robot-assisted - 10.67 %). In the group of tumors with the RENAL index 4-6, the incidence of postoperative complications was 14.7 % with the laparoscopic approach, and 7.1 % with the robot-assisted approach; in the RENAL 7-9 group - 21.9 % and 13.0 %, respectively. In the group of tumors of high complexity (RENAL 10-12), only the robot-assisted approach was used, the incidence of postoperative complications was 22.0 %.Conclusion. Partial nephrectomy for kidney tumors is an effective and safe surgical technique. The incidence of complications when using the laparoscopic approach is higher than when using the robot-assisted technique in groups of tumors of simple and medium complexity. For tumors of high complexity, robot-assisted approach is a priority. The largest number of serious complications is observed with partial nephrectomy with complex tumors.

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Clinical Effectiveness And Safety Of Robot-Assisted Laparoscopic Hysterectomy Versus Traditional Laparotomy For Endometrial Cancer: A Systematic Review

Value in Health ◽

10.1016/j.jval.2015.09.1039 ◽

2015 ◽

Vol 18 (7) ◽

pp. A433

Author(s):

D Park

Keyword(s):

Systematic Review ◽

Endometrial Cancer ◽

Laparoscopic Hysterectomy ◽

Clinical Effectiveness ◽

Robot Assisted

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Management of Middle Hepatic Vein Injury during Laparoscopic Cholecystectomy: A Case Report

The Surgery Journal ◽

10.1055/s-0040-1701695 ◽

2020 ◽

Vol 06 (01) ◽

pp. e47-e48

Author(s):

Juan Jose Santivañez ◽

María Elena Velásquez ◽

Manuel Cadena ◽

Arturo Vergara

Keyword(s):

Laparoscopic Cholecystectomy ◽

Case Report ◽

Hepatic Vein ◽

Intraoperative Complications ◽

Laparoscopic Approach ◽

Middle Hepatic Vein ◽

Management Approach ◽

First Choice ◽

Major Vessel ◽

Vein Injury

Abstract Background Cholecystectomy continues to be the first choice for the treatment of symptomatic cholelithiasis. Especially in patients with acute cholecystitis, a laparoscopic approach has become the standard treatment option. Intraoperative complications of laparoscopic cholecystectomy include: bile duct injury, organ damage, and bleeding due to vascular injury. Difficult hemorrhage during laparoscopic cholecystectomy occurs in 0.1 to 1.9% of all cases. Besides major vessel injuries, gallbladder bed vasculature is reported as a common injury site, mostly secondary to middle hepatic vein lesions. Case Presentation We present a case report of a patient taken for a laparoscopic cholecystectomy. During the procedure, inadvertent middle hepatic vein injury occurs. Here we describe the management approach selected for this type of injury. Discussion We recommend careful dissection during the final steps of a laparoscopic cholecystectomy. Following cystic duct and cystic artery ligation, surgeons often inappropriately relax through the last part of the dissection. During this final dissection, if care is not taken, small vascular structures can be missed and injured.

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Difficult laparoscopic cholecystectomy and preoperative predictive factors

Scientific Reports ◽

10.1038/s41598-021-81938-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Giuseppe Di Buono ◽

Giorgio Romano ◽

Massimo Galia ◽

Giuseppe Amato ◽

Elisa Maienza ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Predictive Factors ◽

Intraoperative Complications ◽

Gallbladder Disease ◽

Control Group ◽

Emergency Setting ◽

Inclusion Criteria ◽

Radiological Findings ◽

Increased Risk

AbstractLaparoscopic cholecystectomy (LC) is the standard technique for treatment of gallbladder disease. In case of acute cholecystitis we can identify preoperative factors associated with an increased risk of conversion and intraoperative complications. The aim of our study was to detect preoperative laboratory and radiological findings predictive of difficult LC with potential advantages for both the surgeons and patients in terms of options for management. We designed a retrospective case–control study to compare preoperative predictive factors of difficult LC in patients treated in emergency setting between January 2015 and December 2019. We included in the difficult LC group the surgeries with operative time > 2 h, need for conversion to open, significant bleeding and/or use of synthetic hemostats, vascular and/or biliary injuries and additional operative procedures. We collected 86 patients with inclusion criteria and difficult LC. In the control group, we selected 86 patients with inclusion criteria, but with no operative signs of difficult LC. The analysis of the collected data showed that there was a statistically significant association between WBC count and fibrinogen level and difficult LC. No association were seen with ALP, ALT and bilirubin values. Regarding radiological findings significant differences were noted among the two groups for irregular or absent wall, pericholecystic fluid, fat hyperdensity, thickening of wall > 4 mm and hydrops. The preoperative identification of difficult laparoscopic cholecystectomy provides an important advantage not only for the surgeon who has to perform the surgery, but also for the organization of the operating block and technical resources. In patients with clinical and laboratory parameters of acute cholecystitis, therefore, it would be advisable to carry out a preoperative abdominal CT scan with evaluation of features that can be easily assessed also by the surgeon.

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Laparoscopic cholecystectomy: Conversion rate and complcation

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v18i3.15305 ◽

2016 ◽

Vol 18 (3) ◽

pp. 43

Author(s):

BR Malla ◽

HN Joshi ◽

N Rajbhandari ◽

YR Shakya ◽

B Karki ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Conversion Rate ◽

Open Cholecystectomy ◽

Gallbladder Disease ◽

Conversion To Open Surgery ◽

Calot’S Triangle ◽

Conversion Rates ◽

Conversion To Open Cholecystectomy ◽

Previous Laparotomy ◽

History Of

Introduction and Objective: Laparoscopic Cholecystectomy is the standard surgical treatment for gallbladder disease. However, conversion to open surgery is not the complication. Different centers have reported different conversion rates and post operative complications. The objective of this study is to identify conversion rate and post operative complication of laparoscopic cholecystectomyMaterials and Methods: This retrospective study included all laparoscopic cholecystectomies attempted in Dhulikhel hospital during the year 2015. Files of all patients were reviewed to find out the demography of the patients and the indication of Laparoscopic cholecystectomy. The rate of conversion to open cholecystectomy, the underlying reasons for conversion and postoperative complications were analyzed.Results: Out of 324 cases attempted laparoscopic cholecystetomies, two cases with the history of previous laparotomy were excluded to rule out the bias in the result. Out of 322 cases 226(70.18%)were female and 96(29.81%) were male . The mean age was 38 years. Over all conversion rate to open cholecystetomy was 1.86% with frozen calot’s triangle as the most common reason for conversion. The over all postoperative complication was 1.24% with no major bile duct injury.Conclusion: Laparoscopic cholecystectomy can safely be done with low conversion rate and complication.

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Feasibility of Single-Port Cholecystectomy With Wound Retractor and a Glove in a Rural Hospital in Mexico

International Surgery ◽

10.9738/intsurg-d-15-00061.1 ◽

2019 ◽

Vol 103 (9-10) ◽

pp. 468-472

Author(s):

Santiago Sherwell-Cabello ◽

Mario Rodarte-Shade ◽

Eduardo Flores-Villalba

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Port ◽

Laparoscopic Approach ◽

Rural Hospital ◽

Surgical Morbidity ◽

Conventional Laparoscopic ◽

Sterile Glove ◽

Laparoscopic Equipment ◽

Wound Retractor ◽

Surgical Option

Laparoscopic surgery has been established as the standard therapy for symptomatic cholecystolithiasis. Now, single-port cholecystectomy is a surgical option. Due to the need of special laparoscopic instruments and devices, the cost of the surgery is significantly increased, limiting its popularity in most medical centers in developing countries, especially in rural areas. This paper's objective was to show the safety, reproducibility, and feasibility of single-port laparoscopic cholecystectomy using conventional laparoscopic equipment, a wound retractor, and a sterile glove in a rural hospital in Mexico. A prospective study was carried out from July to October 2014. Patients diagnosed with uncomplicated cholecystolithiasis who agreed to participate were operated with this technique. Complications, operative time, bleeding, evolution, and length of hospital stay were recorded. A total of 24 women went onto surgery under this approach. A mean follow-up of 71 days was completed. No incisional hernias, bile duct injuries, wound infection, nor death was presented. Surgical time and cost were not significantly increased compared to conventional laparoscopic approach. Most patient discharge was done the same day of the surgery. Single-port laparoscopic cholecystectomy is a cost-effective procedure, which can be performed in all hospitals where an Alexis retractor and conventional laparoscopic equipment is available. There was no increase of surgical morbidity. The single-port cholecystectomy is a technically feasible and safe surgical option in selected patients and can be easily performed in rural hospitals at a low cost, providing the benefits of the single incision.

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Gallbladder perforation with liver abscess; laparoscopic cholecystectomy converted to open: a case report

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214719 ◽

2021 ◽

Vol 9 (12) ◽

pp. 3685

Author(s):

Edgar Salvador Salas Ochoa ◽

Maria Eugenia Dominguez Gutierrez ◽

Alfredo Lopez Rocha ◽

Edilia Naraleth Arce Sanchez ◽

Karla Itzel Altamirano Moreno ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Acute Cholecystitis ◽

Liver Abscess ◽

Rare Complication ◽

Gallbladder Disease ◽

Laparoscopic Approach ◽

Abdominal Ultrasound ◽

The United States ◽

Gallbladder Perforation ◽

Public Care

Gallbladder disease affects more than 20 million people in the United States. Acute cholecystitis is a clinic entity characterized by the inflammation of the vesicular wall that is usually manipulated by abdominal pain, right hypochondrial sensitivity and fever. The technique of choice for the diagnosis of cholecystitis is abdominal ultrasound; gallbladder perforation is a rare complication of acute cholecystitis (2%-11%). The presence of perivesicular abscesses is infrequent, its prevalence varies between 2.1% and 19.5%. Clinical record was reviewed of a 73 years old woman who attended a second level public care unit, with a clinical picture of acute chronic lithiasis cholecystitis, who underwent surgery consisting of open converted laparoscopic cholecystectomy with a finding of vesicular perforation with liver abscess, it was initiated with laparoscopic approach, it was not possible to identify anatomical structures, so it was decided to convert to open surgery. Cholecystectomy and abdominal lavage are usually sufficient in the treatment of gallbladder perforation.

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Radical prostatectomy technique in the robotic evolution: from da Vinci standard to single port—a single surgeon pathway

Journal of Robotic Surgery ◽

10.1007/s11701-021-01194-8 ◽

2021 ◽

Author(s):

Simone Francavilla ◽

Alessandro Veccia ◽

Ryan W. Dobbs ◽

Fabio Zattoni ◽

Hari T. Vigneswaran ◽

...

Keyword(s):

Radical Prostatectomy ◽

Da Vinci ◽

Single Port ◽

Intraoperative Complications ◽

Perioperative Outcomes ◽

Standard Group ◽

Robot Assisted ◽

Conversion To Open Surgery ◽

Major Complications ◽

The Difference

AbstractTo describe perioperative outcomes following robot-assisted prostatectomy performed by a single surgeon during transitions between da Vinci standard/Si/Xi and the single port. Perioperative data were retrospectively evaluated of the first 40 consecutive robot-assisted radical prostatectomies performed by a single surgeon using the da Vinci standard, Si, Xi and single port. A total of 160 patients were included. We matched standard vs Si (Match 1), Si vs Xi (Match 2) and Xi vs single port (Match 3) cohort. Mann–Whitney and Fisher’s tests were used to test the difference among the groups. Univariate and multivariate logistic regression analyses were adopted to evaluate the predictors of overall and major complications. Single-port procedures in Match 3 showed significant shorter median operative time than Xi. Both Si and single-port groups showed significantly less median blood loss, a shorter median length of stay, respectively, than standard group in Match 1 and than Xi group in Match 3. 1 standard group patient required conversion to open surgery for an unsolvable conflict of the robotic arms. No other intraoperative complications were noted. On univariate and multivariate analyses, the da Vinci platform model was not a predicting factor of major complications (Clavien–Dindo ≥ 3). We described how technological progress impacted peri and postoperative outcomes during transitions between robotic surgical platforms for radical prostatectomy. In particular, the technological improvements associated to the increased surgeon’s expertise made the transition to the single port safe and effective when compared with previous platforms.

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