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

다국어 초록 (Multilingual 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.

참고문헌 (Reference)

1 정진용, "단일통로 복강경 담낭 절제수술의 초기경험" 대한내시경복강경외과학회 13 (13): 17-21, 2010

2 Ruiz-Rabelo JF, "Validation of the NASA-TLX Score in Ongoing Assessment of Mental Workload During a Laparoscopic Learning Curve in Bariatric Surgery" 25 : 2451-2456, 2015

3 Omori T, "Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer" 25 : 2400-2404, 2011

4 Hartrick CT, "The numeric rating scale for clinical pain measurement: a ratio measure" 3 : 310-316, 2003

5 Qiu J, "Single-port versus conventional multiport laparoscopic cholecystectomy: a metaanalysis of randomized controlled trials and nonrandomized studies" 23 : 815-831, 2013

6 Lee H, "Single-incision robotic cholecystectomy: A special emphasis on utilization of transparent glove ports to overcome limitations of single-site port" 13 : 2017

7 Hirano Y, "Single-incision laparoscopic surgery for colorectal cancer" 8 : 95-100, 2016

8 Marks JM, "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" 216 : 1037-1047, 2013

9 Montero PN, "Single incision laparoscopic surgery (SILS) is associated with poorer performance and increased surgeon workload compared with standard laparoscopy" 77 : 73-77, 2011

10 Stefanidis D, "Robotic assistance improves intracorporeal suturing performance and safety in the operating room while decreasing operator workload" 24 : 377-382, 2010

11 Frutos MD, "Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy" 257 : 413-418, 2013

12 Jørgensen LN, "Randomized clinical trial of singleversus multi-incision laparoscopic cholecystectomy" 101 : 347-355, 2014

13 Sarli L, "Randomized clinical trial of laparoscopic cholecystectomy performed with mini-instruments" 90 : 1345-1348, 2003

14 Lai EC, "Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy" 202 : 254-258, 2011

15 Dulan G, "Proficiency-based training for robotic surgery: construct validity, workload, and expert levels for nine inanimate exercises" 26 : 1516-1521, 2012

16 Sodergren MH, "Pain, wellbeing, body image and cosmesis: a comparison of single-port and four-port laparoscopic cholecystectomy" 23 : 223-229, 2014

17 Bisgaard T, "Microla-p aroscopic vs conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial" 16 : 458-464, 2002

18 Begos DG, "Laparoscopic cholecystectomy: from gimmick to gold standard" 19 : 325-330, 1994

19 Phillips MS, "Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy" 26 : 1296-1303, 2012

20 Abdelrahman AM, "Impact of singleincision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial" 30 : 1205-1211, 2016

21 Asakuma M, "Impact of single-port cholecystectomy on postoperative pain" 98 : 991-995, 2011

22 Hart SG, "Human mental workload" Elsevier 1988

23 Yurko YY, "Higher mental workload is associated with poorer laparoscopic performance as measured by the NASA-TLX tool" 5 : 267-271, 2010

24 Scerbo MW, "Differences in mental workload between traditional and single-incision laparoscopic procedures measured with a secondary task" 213 : 244-248, 2017

25 Kudsi OY, "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" 31 : 3242-3250, 2017

26 Dunker MS, "Cosmesis and body image after laparoscopic- assisted and open ileocolic resection for Crohn’s disease" 12 : 1334-1340, 1998

27 Lurje G, "Cosmesis and Body Image in Patients Undergoing Single-port Versus Conventional Laparoscopic Cholecystectomy: A Multicenter Doubleblinded Randomized Controlled Trial (SPOCC-trial)" 262 : 728-734, 2015

28 Novitsky YW, "Advantages of mini-laparoscopic vs conventional laparoscopic cholecystectomy: results of a prospective randomized trial" 140 : 1178-1183, 2005

29 Strosberg DS, "A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis" 31 : 1436-1441, 2017

30 Gonzalez A, "A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases" 30 : 2951-2960, 2016

31 Gustafson M, "A comparison of robotic single-incision and traditional single-incision laparoscopic cholecystectomy" 30 : 2276-2280, 2016

32 Balachandran B, "A Comparative Study of Outcomes Between Single-Site Robotic and Multi-port Laparoscopic Cholecystectomy: An Experience from a Tertiary Care Center" 41 : 1246-1253, 2017