Minimally Invasive Single-Site Cholecystectomy in  Obese Patients: Laparoscopic vs. Robotic

이규민,강창무,한대훈,노승윤,황호경,이우정 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.3

Purpose: Laparoscopic cholecystectomy is treatment method for management of benign gallbladder diseases. Further attempts are made to operate single-port laparoscopic cholecystectomy. However, single-port laparoscopic cholecystectomy, the procedure remains technically difficult, especially in obese patient. Recently, a robotic surgical system for minimal invasive surgery was introduced to overcome the limitations of conventional laparoscopic surgery. Methods: From April 2009 to August 2017, we retrospectively reviewed the medical records of patients with single-site, minimally invasive (laparoscopic and robotic) cholecystectomy with high BMI (>25 kg/m2). We analyzed general characteristics and perioperative outcomes between the single-fulcrum laparoscopic cholecystectomy group and the robotic single-site cholecystectomy (RSSC) group. Results: Operation time (57.56±11.10 vs 98.5±12.28 p<0.001) was significantly longer and postoperative pain score (3.61 vs 5.15 p=0.000) was significantly higher in the robotic single-site cholecystectomy (RSSC) group, but the actual dissection time (25.85±11.09 vs 25.79±13.35 p=0.978) was not significantly different between the two approaches. Iatrogenic gallbladder perforation, (13 vs 6 p=0.005), patients undergoing RSSC showed a significantly smaller amount than did those undergoing single-fulcrum laparoscopic cholecystectomy (SFLC). Conclusion: It is difficult to say for certain that RSSC is clearly better than SFLC in obese patients. However, because of the technical convenience and efficiency of surgery with RSSC, RSSC can be practically worthwhile. Further study is mandatory.

Comparison of Single-Incision Robotic Cholecystectomy, Single- Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Hyeong Seok Kim, M.D.,Youngmin Han, M.S.,Jae Seung Kang, M.D.,Doo-ho Lee, M.D.,Jae Ri Kim, M.D., M.S.,Wooil Kwon, M.D., Ph.D.,Sun-Whe Kim, M.D., Ph.D.,Jin-Young Jang, M.D., Ph.D. 대한내시경복강경외과학회 2018 Journal of Minimally Invasive Surgery Vol.21 No.4

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.

Initial experiences of robotic SP cholecystectomy: a comparative analysis with robotic Si single-site cholecystectomy

Charles Jimenez Cruz,Frederick Huynh,Incheon Kang,Woo Jung Lee,Chang Moo Kang 대한외과학회 2021 Annals of Surgical Treatment and Research(ASRT) Vol.100 No.1

Purpose: The da Vinci SP robotic surgical system (Intuitive Surgical) offers pure SP with 4 lumens, which accommodates the fully-wristed endoscope and 3 arms with multijoint feature. We herein present our initial experience of the da Vinci SP surgical system in robotic single-site cholecystectomy. Methods: Thirty consecutive patients with a preoperative diagnosis of gallstones and/or chronic cholecystitis who underwent robotic SP cholecystectomy (RSPC) using da Vinci SP surgical system from January to May 2019 were reviewed. The perioperative outcomes were assessed and compared with those performed using Si-robotic single-site surgical system. Results: Mean docking time was 5.2 minutes. The mean actual dissection time was 14.6 minutes while the mean operation time was 75.1 minutes. Postoperative course was unremarkable and patients were discharged after a mean hospital stay of 1.5 days. In comparative analysis, operation time (109.5 ± 30.0 minutes vs. 75.1 ± 17.5 minutes, P = 0.001), docking time (11.9 ± 4.3 minutes vs. 5.2 ± 1.9 minutes, P = 0.001), actual dissection time (34.6 ± 18.4 minutes vs. 14.6 ± 5.1 minutes, P = 0.001), console time (58.7 ± 23.0 minutes vs. 32.4 ± 11.6 minutes, P = 0.001), immediate postoperative pain (4.6 ± 1.3 vs. 3.2 ± 1.0, P = 0.001), and pain prior to discharge (2.0 ± 0.6 vs. 1.4 ± 0.0, P = 0.002) were significantly improved in RSPC. Conclusion: RSPC is feasible, safe, and effective. The perioperative outcomes are better compared with Si-robotic single-site surgical systems.

The First Experiences of Robotic Single-Site Cholecystectomy in Asia: A Potential Way to Expand Minimally-Invasive Single-Site Surgery?

이성환,강창무,정명재,황호경,이우정 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.1

Purpose: Herein, we firstly present the robotic single-site cholecystectomy (RSSC) as performed in Asia and evaluate whether it could overcome the limitations of conventionallaparoscopic single-site cholecystectomy. Materials and Methods: From October 2013 to November 2013, RSSC for benign gallbladder (GB) disease was firstly performed consecutively in five patients. We evaluated these early experiences of RSSC and compared factors including clinicopathologic factors and operative outcomeswith our initial cases of single-fulcrum laparoscopic cholecystectomy (SFLC). Results: Four female patients and one male patient underwent RSSC. Neither open conversion nor bile duct injury or bile spillage was noted during surgery. In comparisonswith SFLC, patient-related factors in terms of age, sex, Body Mass Index, diagnosis,and American Society of Anesthesiologist score showed no significant differencesbetween two groups. There were no significant differences in the operative outcomes regarding intraoperative blood loss, bile spillage during operation, postoperativepain scale values, postoperative complications, and hospital stay between the two groups (p<0.05). Actual dissection time (p=0.003) and total operation time (p=0.001) were significantly longer in RSSC than in SFLC. There were no drain insertionor open conversion cases in either group. Conclusion: RSSC provides a comfortableenvironment and improved ergonomics to laparoscopic single-site cholecystectomy;however, this technique needs to be modified to allow for more effective intracorporeal movement. As experience and technical innovations continue, RSSC will soon be alternative procedure for well-selected benign GB disease.

Minimally Invasive Single-Site Cholecystectomy in Obese Patients: Laparoscopic vs. Robotic

장진영,김형석 대한내시경복강경외과학회 2019 Journal of Minimally Invasive Surgery Vol.22 No.3

Robotic single-site cholecystectomy (RSSC) has emerged as an alternative procedure to overcome the shortcomings of single-fulcrum laparoscopic cholecystectomy in terms of the ergonomics and reducing the physical and mental stress of the surgeon. It is also necessary to assess the safety of RSSC for obese patients in a world with an increasing population of obese people. RSSC took a longer operation time, but the actual dissection time was similar to that of single-fulcrum laparoscopic cholecystectomy. There was no difference in postoperative pain, except for during the immediate postoperative period, and in the length of the hospital stay. RSSC had the advantage of reducing the incidence of intraoperative iatrogenic gallbladder perforation. It is critical to prevent any intraoperative bile leakage, which is associated as a worse prognostic factor in those patients with gallbladder cancer. Additional studies with a prospective design and larger number of study subjects will be required to confirm the safety and feasibility of RSSC. Moreover, the cost benefit and safety for treating malignant lesions are also issues to be addressed. RSSC is expected to be further expanded as an operative mode in the future.

Intelligent Interaction based on a Surgery Task Model for a Surgical Assistant Robot: Awareness of Current Surgical Stages based on a Surgical Procedure Model

권동수,고성영,이우정 제어·로봇·시스템학회 2010 International Journal of Control, Automation, and Vol.8 No.4

This paper deals with providing a surgical robot with awareness of the current surgical stage. The awareness of the surgical stage is the first step toward a natural interaction between a surgeon and a surgical robot, the ultimate goal of which is to help the surgeon perform surgery with a minimum control burden. For this purpose, a surgery task model was defined as a structured form of surgical knowledge, which can be understood by both the surgeon and the robot. The model consists of three components: a surgical procedure model, input information, and an action strategy at each surgical stage. This paper focuses on the awareness of current surgical stages based on the surgical procedure model. The surgical procedure model represents the sequential information of the surgery and it is ar-ranged based on key surgical stages. To implement the surgical procedure model of a cholecystectomy, 21 cases of human cholecystectomies are decomposed into surgical stages and their relations are then analyzed. To deal with uncertainty, interaction functions are introduced to the model. While further ex-periments are necessary, it was shown that the key stages-based surgical procedure model could esti-mate the key surgical stages correctly during one case of in vivo porcine cholecystectomy.

Technical Compensation for Hepatic Vein Injury during Robotic Single Site Cholecystectomy

Jae Uk Chong,Myung Jae Jung,강창무 대한내시경복강경외과학회 2016 Journal of Minimally Invasive Surgery Vol.19 No.3

This video describes an event that could occur during any cholecystectomy. To the best of our knowledge, this video is the first description of the technical compensation for hepatic vein injury during robotic single-site cholecystectomy (RSSC). A 61-year-old male with a 1.6 cm gallbladder stone sought to go through with RSSC. During dissection of gallbladder from the liver bed, the hepatic vein was unexpectedly exposed and injured. Using the angulated robotic needle holder, the injured hepatic vein was repaired with 5-0 prolene monofilament suture. Although there is a lack of EndoWrist movement in RSSC, suturing was feasible. The patient was discharged on the second postoperative day without complications. Incidental hepatic vein injury could be safely managed using RSSC and prevent the need for conversion to a conventional laparoscopic or open approach.

Technical feasibility of da Vinci SP single-port robotic cholecystectomy: a case report

Charles Jimenez Cruz,Hye Yeon Yang,Incheon Kang,강창무,이우정 대한외과학회 2019 Annals of Surgical Treatment and Research(ASRT) Vol.97 No.4

The da Vinci surgical system released its new pure single-port platform, the da Vinci SP, offering improvements and refinements for established robotic single-site procedures. Herein, we present the first case of robotic single-site cholecystectomy using the da Vinci SP system (RSPC) demonstrating its safety and technical feasibility. A 59-year-old female with chronic calculus cholecystitis was admitted for elective RSPC. Docking time took 6 minutes. The patient underwent successful RSPC with a total operation time of 89 minutes. There was no significant intraoperative event. The patient had unremarkable postoperative course. Multijoint instruments, simple docking process, and third-arm functionality are among the RSPC’s advantages. Absence of the port for an assistant surgeon can be a hindrance in performing more complicated surgeries. The present case suggests that RSPC is safe and feasible. The promising features and potential application of da Vinci SP in hepatobiliary and pancreas surgery need further study

Robotic Cholecystectomy Using the Newly Developed Korean Robotic Surgical System, Revo-i: A Preclinical Experiment in a Porcine Model

강창무,이우정,정재욱,임진홍,박동원,박성준,김수현,예혜진,김세훈 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.5

One Korean company recently successfully produced a robotic surgical system prototype called Revo-i (MSR-5000). We, therefore,conducted a preclinical study for robotic cholecystectomy using Revo-i, and this is a report of the first case of robotic cholecystectomyperformed using the Revo-i system in a preclinical porcine model. Revo-i consists of a surgeon console (MSRC-5000), operation cart (MSRO-5000) and vision cart (MSRV-5000), and a 40 kg-healthy female porcine was prepared for robotic cholecystectomywith general anesthesia. The primary end point was the safe completion of these procedures using Revo-i: The total operationtime was 88 minutes. The dissection time was defined as the time from the initial dissection of the Calot area to the time to complete gallbladder detachment from the liver bed: The dissection time required 14 minutes. The surgical console time was 45 minutes. There was no gallbladder perforation or significant bleeding noted during the procedure. The porcine survived for two weeks postoperatively without any complications. Like the da Vinci surgical system, the Revo-i provides a three-dimensional operative view and allows for angulated instrument motion (forceps, needle-holders, clip-appliers, scissors, bipolar energy, and hook monopolar energy), facilitating an effective laparoscopic procedure. Our experience suggests that robotic cholecystectomy can be safely completed in a porcine model using Revo-i.

Comparison of the outcomes of robotic cholecystectomy and laparoscopic cholecystectomy

Eun Kyoung Lee,Eunyoung Park,Won-Oak Oh,Nah-Mee Shin 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.1

Purpose: This study compared the effects of robotic single-port cholecystectomy (RC) and 3-port laparoscopic cholecystectomy (LC) on patients’ surgical pain, postoperative complications, and satisfaction. Methods: One hundred twenty patients with gallbladder disease scheduled for either LC or RC were recruited. Each patient was followed up for 1 week after hospital discharge. Results: Time stayed in operating room was longer in patients with RC, however their hospital stay was shorter than those with LC (t = 3.01, P = 0.003). Since patients with RC received more analgesics during the surgery (t = 3.98, P < 0.001), all participants’ surgical pain level were analyzed by using analysis of covariance. Patients who underwent RC reported less surgical pain consistently at 6 hours and first day after surgery and 2 days and 1 week later than patients in the LC. Repeated measure analysis of variance also demonstrated that the RC with single-port might cause less pain throughout the postoperative period (F = 25.68, P < 0.001). Participants’ conditions appeared stable without complications such as infection or bleeding regardless of the surgical type however, overall satisfaction with RC showed significantly higher than those with LC except for one item, “the cost of surgery.” Conclusion: These results suggested that the RC might be a better choice for people who concern about surgical pain and early hospital discharge. Since there were no differences in postoperative health status between the 2 groups, health care providers as an advocate can provide more reliable information to their patients.