Top

Published in:

Open Access 01-12-2021 | Cholecystectomy | Systematic review update

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

Authors: Rivfka Shenoy, Michael A. Mederos, Linda Ye, Selene S. Mak, Meron M. Begashaw, Marika S. Booth, Paul G. Shekelle, Mark Wilson, William Gunnar, Melinda Maggard-Gibbons, Mark D. Girgis

Published in: Systematic Reviews | Issue 1/2021

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

Available only for authorised users

Childers CP, Maggard-Gibbons M. Estimation of the acquisition and operating costs for robotic surgery. JAMA Surg. 2018;320(8):835–6. https://doi.org/10.1001/jama.2018.9219.CrossRef

Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D. Review of emerging surgical robotic technology. Surg Endosc. 2018;32(4):1636–55. https://doi.org/10.1007/s00464-018-6079-2.CrossRefPubMed

Alemzadeh H, Raman J, Leveson N, Kalbarczyk Z, Iyer RK. Adverse events in robotic surgery: a retrospective study of 14 years of FDA data. PLoS One. 2016;11(4):e0151470. https://doi.org/10.1371/journal.pone.0151470.CrossRefPubMedPubMedCentral

Tsui C, Klein R, Garabrant M. Minimally invasive surgery: national trends in adoption and future directions for hospital strategy. Surg Endosc. 2013;27(7):2253–7. https://doi.org/10.1007/s00464-013-2973-9.CrossRefPubMed

Cianci S, Rosati A, Rumolo V, Gueli Alletti S, Gallotta V, Turco LC, et al. Robotic single-port platform in general, urologic, and gynecologic surgeries: a systematic review of the literature and meta-analysis. World J Surg. 2019;43(10):2401–19. https://doi.org/10.1007/s00268-019-05049-0.CrossRefPubMed

Han C, Shan X, Yao L, Yan P, Li M, Hu L, et al. Robotic-assisted versus laparoscopic cholecystectomy for benign gallbladder diseases: a systematic review and meta-analysis. Surg Endosc. 2018;32(11):4377–92. https://doi.org/10.1007/s00464-018-6295-9.CrossRefPubMed

Huang Y, Chua TC, Maddern GJ, Samra JS. Robotic cholecystectomy versus conventional laparoscopic cholecystectomy: a meta-analysis. Surgery. 2017;161(3):628–36. https://doi.org/10.1016/j.surg.2016.08.061.CrossRefPubMed

Sun N, Zhang J, Zhang C, Shi Y. Single-site robotic cholecystectomy versus multi-port laparoscopic cholecystectomy: a systematic review and meta-analysis. Am J Surg. 2018;216(6):1205–11. https://doi.org/10.1016/j.amjsurg.2018.04.018.CrossRefPubMed

Sun N, Zhang JL, Zhang CS, Li XH, Shi Y. Single-incision robotic cholecystectomy versus single-incision laparoscopic cholecystectomy: a systematic review and meta-analysis. Medicine. 2018;97(36):e12103. https://doi.org/10.1097/MD.0000000000012103.CrossRefPubMedPubMedCentral

10.

Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928.CrossRefPubMedPubMedCentral

11.

Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.CrossRefPubMedPubMedCentral

12.

Schünemann H BJ, Guyatt G, Oxman A, editors. GRADE handbook for grading quality of evidenceand strength of recommendations. Updated October 2013. The Grade Working Group, 2013. Available at: https://gdt.gradepro.org/app/handbook/handbook.html. Accessed 15 Apr 2021.

13.

Abel SA, Al-Lami HS, Zeineddin S, Chandra A, Bingener-Casey J, Lyden ML. Robotic-assisted single site cholecystectomy and the obese patient: single center outcomes data. J Am College Surg. 2019;229(4):S112–S3. https://doi.org/10.1016/j.jamcollsurg.2019.08.205.CrossRef

14.

Aggarwal R, Winter Beatty J, Kinross J, von Roon A, Darzi A, Purkayastha S. Initial experience with a new robotic surgical system for cholecystectomy. Surg Innov 2020;27(2):136-142, 2, DOI: https://doi.org/10.1177/1553350619890736.

15.

Albrecht R, Haase D, Zippel R, Koch H, Settmacher U. Robot-assisted surgery - progress or expensive toy? matched-pair comparative analysis of robot-assisted cholecystectomy vs. laparoscopic cholecystectomy. Der Chirurg. 2017;88(12):1040–5. https://doi.org/10.1007/s00104-017-0466-4.CrossRef

16.

Altieri MS, Yang J, Telem DA, Zhu J, Halbert C, Talamini M, et al. Robotic approaches may offer benefit in colorectal procedures, more controversial in other areas: a review of 168,248 cases. Surg Endosc. 2016;30(3):925–33. https://doi.org/10.1007/s00464-015-4327-2.CrossRefPubMed

17.

Aragon RJ, Lin C, Vidovszky TJ, Carr AD, Ali MR. Innovative approaches to laparoscopic cholecystectomy: a comparison of outcomes for single incision laparoscopic cholecystectomy, multi-port robotic cholecystectomy, and single site robotic cholecystectomy. Surg Endosc. 2014;28:437.

18.

Autin RL, Singh TP, Binetti B. Incidence of port site hernia following single site laparoscopic and robotic cholecystectomy. Surg Endosc. 2015;29:S469.

19.

Balachandran B, Hufford TA, Mustafa T, Kochar K, Sulo S, Khorsand 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(5):1246–53. https://doi.org/10.1007/s00268-016-3799-0.CrossRefPubMed

20.

Buzad FA, Corne LM, Brown TC, Fagin RS, Hebert AE, Kaczmarek CA, et al. Single-site robotic cholecystectomy: efficiency and cost analysis. Int J Med Robot. 2013;9(3):365–70.CrossRefPubMed

21.

Calatayud D, Kakarla VR, Coratti F, Raimondi P, D’Ugo S, Milone L, et al. Minimally invasive cholecystectomy-retrospective study comparing laparoscopic vs robotic approach. Surg Endosc. 2012;26:S413.CrossRef

22.

Chung PJ, Huang R, Policastro L, et al. Single-Site Robotic Cholecystectomy at an Inner-City Academic Center. JSLS. 2015;19(3):e2015.00033. https://doi.org/10.4293/JSLS.2015.00033.

23.

Eid JJ, Jyot A, Macedo FI, Sabir M, Mittal VK. Robotic cholecystectomy is a safe educational alternative to laparoscopic cholecystectomy during general surgical training: a pilot study. J Surg Educ. 2020;77(5):1266–70. https://doi.org/10.1016/j.jsurg.2020.02.027.CrossRefPubMed

24.

Farnsworth J, Surrusco M, Luo-Owen X, Yung E, Srikureja D, Mukherjee K. Is there a role for the robot in acute care surgery? J Invest Med. 2018;66(1):180–1.

25.

Farukhi MA, Davis B. Robotic vs laparoscopic cholecystectomy: which technique is optimal in morbidly obese patients? Surg Endosc. 2017;31:S327.

26.

Gonzalez AM, Rabaza JR, Donkor C, Romero RJ, Kosanovic R, Verdeja JC. Single-incision cholecystectomy: a comparative study of standard laparoscopic, robotic, and SPIDER platforms. Surg Endosc. 2013;27(12):4524–31. https://doi.org/10.1007/s00464-013-3105-2.CrossRefPubMed

27.

Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial. Surg Endosc. 2019;33(5):1482–90. https://doi.org/10.1007/s00464-018-6430-7.CrossRefPubMed

28.

Gustafson M, Lescouflair T, Kimball R, Daoud I. A comparison of robotic single-incision and traditional single-incision laparoscopic cholecystectomy. Surg Endosc. 2016;30(6):2276–80. https://doi.org/10.1007/s00464-015-4223-9.CrossRefPubMed

29.

Hagen ME, Balaphas A, Jung MK, Buchs NC, Buehler L, Morel P. Robotic single site versus multiport cholecystectomy: a case-matched analysis of short-and long-term costs. Surg Endosc. 2017;31:S53.

30.

Hagen ME, Balaphas A, Podetta M, Rohner P, Jung MK, Buchs NC, et al. Robotic single-site versus multiport laparoscopic cholecystectomy: a case-matched analysis of short- and long-term costs. Surg Endosc. 2018;32(3):1550–5. https://doi.org/10.1007/s00464-017-5843-z.CrossRefPubMed

31.

Hawasli A, Sahly M, Meguid A, Edhayan E, Guiao C, Szpunar S. The impact of robotic cholecystectomy on private practice in a community teaching hospital. Am J Surg. 2016;211(3):610–4. https://doi.org/10.1016/j.amjsurg.2015.11.010.CrossRefPubMed

32.

Heemskerk J, Zandbergen HR, Keet SW, Martijnse I, van Montfort G, Peters RJ, et al. Relax, it’s just laparoscopy! A prospective randomized trial on heart rate variability of the surgeon in robot-assisted versus conventional laparoscopic cholecystectomy. Digest Surg. 2014;31(3):225–32. https://doi.org/10.1159/000365580.CrossRef

33.

Higgins RM, Frelich MJ, Bosler ME, Gould JC. Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc. 2017;31(1):185–92. https://doi.org/10.1007/s00464-016-4954-2.CrossRefPubMed

34.

Jang EJ, Roh YH, Kang CM, Kim DK, Park KJ. Single-port laparoscopic and robotic cholecystectomy in obesity (>25 kg/m²). JSLS. 2019;23(2):e2019.00005. https://doi.org/10.4293/JSLS.2019.00005.

35.

Kaminski JP, Bueltmann KW, Rudnicki M. Robotic versus laparoscopic cholecystectomy inpatient analysis: does the end justify the means? J Gastrointest Surg. 2014;18(12):2116–22.CrossRefPubMed

36.

Kane WJ, Charles EJ, Mehaffey JH, Hawkins RB, Meneses KB, Tache-Leon CA, et al. Robotic compared with laparoscopic cholecystectomy: a propensity matched analysis. Surgery. 2020;167(2):432–5. https://doi.org/10.1016/j.surg.2019.07.020.CrossRefPubMed

37.

Khorgami Z, Li WT, Jackson TN, Howard CA, Sclabas GM. The cost of robotics: an analysis of the added costs of robotic-assisted versus laparoscopic surgery using the National Inpatient Sample. Surg Endosc. 2019;33(7):2217–21. https://doi.org/10.1007/s00464-018-6507-3.CrossRefPubMed

38.

Kudsi OY, Castellanos A, Kaza S, McCarty J, Dickens E, Martin D, 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(8):3242–50. https://doi.org/10.1007/s00464-016-5353-4.CrossRefPubMed

39.

Lee GI, Lee MR, Green I, Allaf M, Marohn MR. Surgeons’ physical discomfort and symptoms during robotic surgery: a comprehensive ergonomic survey study. Surg Endosc. 2017;31(4):1697–706. https://doi.org/10.1007/s00464-016-5160-y.CrossRefPubMed

40.

Lee SR, Kim HO, Shin JH. Clinical outcomes of single-incision robotic cholecystectomy versus conventional 3-port laparoscopic cholecystectomy. Can J Surg. 2019;62(1):52–6. https://doi.org/10.1503/cjs.000118.CrossRefPubMedPubMedCentral

41.

Lescouflair T, Gustafson M, Daoud I. A comparison of robotic single incision and traditional single incision laparoscopic cholecystectomy. Surg Endosc. 2014;28:286.

42.

Li YP, Wang SN, Lee KT. Robotic versus conventional laparoscopic cholecystectomy: a comparative study of medical resource utilization and clinical outcomes. Kaohsiung J Med Sci. 2017;33(4):201–6. https://doi.org/10.1016/j.kjms.2017.01.010.CrossRefPubMed

43.

Main WPL, Mitko JM, Hussain LR, Meister KM, Kerlakian GM. Robotic versus laparoscopic cholecystectomy in the obese patient. Am Surg. 2017;83(11):e447–e9.CrossRefPubMed

44.

Mitko J, Main W, Hussain L, Meister K, Kerlakian G, Tymitz K. Laparoscopic versus robotic cholecystectomy in the obese population: is there a preferred approach? Surg Obes Relat Dis. 2016;12(7):S114–S5. https://doi.org/10.1016/j.soard.2016.08.178.CrossRef

45.

Moore MD, Abelson J, Tholey R, Panjwani S, Zarnegar R, Afaneh C. Robotic single-incision cholecystectomy, although a feasible and safe option, dramatically increases operative time when compared to single-incision laparoscopic cholecystectomy. Surg Endosc. 2016;30:S494.

46.

Pietrabissa A, Pugliese L, Vinci A, Peri A, Tinozzi FP, Cavazzi E, et al. Short-term outcomes of single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective, randomized, double-blind trial. Surg Endosc. 2016;30(7):3089–97. https://doi.org/10.1007/s00464-015-4601-3.CrossRefPubMed

47.

Pokala B, Flores L, Armijo PR, Kothari V, Oleynikov D. Robot-assisted cholecystectomy is a safe but costly approach: a national database review. Am J Surg. 2019;218(6):1213–8. https://doi.org/10.1016/j.amjsurg.2019.08.014.CrossRefPubMed

48.

Rosemurgy A, Ryan C, Klein R, Sukharamwala P, Wood T, Ross S. Does the cost of robotic cholecystectomy translate to a financial burden? Surg Endosc. 2015;29(8):2115–20. https://doi.org/10.1007/s00464-014-3933-8.CrossRefPubMed

49.

Ross S, Klein R, Ryan C, Toomey P, Sukharamwala P, Rosemurgy A. Does the cost of robotic cholecystectomy translate to a financial burden? Surg Endosc. 2014;28:247.CrossRef

50.

Spinoglio G, Lenti LM, Maglione V, Lucido FS, Priora F, Bianchi PP, et al. Single-site robotic cholecystectomy (SSRC) versus single-incision laparoscopic cholecystectomy (SILC): comparison of learning curves. First European experience. Surg Endosc. 2012;26(6):1648–55. https://doi.org/10.1007/s00464-011-2087-1.CrossRefPubMed

51.

Strosberg DS, Nguyen MC, Muscarella IP, Narula VK. A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis. Surg Endosc. 2016;30:S491.

52.

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(3):1436–41. https://doi.org/10.1007/s00464-016-5134-0.CrossRefPubMed

53.

Su WL, Huang JW, Wang SN, Lee KT. Comparison study of clinical outcomes between single-site robotic cholecystectomy and single incision laparoscopic cholecystectomy. Asian J Surg. 2017;40(6):424–8. https://doi.org/10.1016/j.asjsur.2016.03.005.CrossRefPubMed

54.

Teoh AY, Ng EK, Chan SM, Yip HC, Wong VW, Chiu PW. Endowrist equipped robotic laparoendoscopic single site access cholecystectomy versus 4 port laparoscopic cholecystectomy. A prospective comparative study. Surg Endosc. 2017;31:S328.

55.

Wren SM, Curet MJ. Single-port robotic cholecystectomy: results from a first human use clinical study of the new da Vinci single-site surgical platform. Arch Surg. 2011;146(10):1122–7.CrossRefPubMed

56.

Lee JH, Song KB, Shin SH, Kim SC, Lee YJ, Park KM. Robotic single-site cholecystectomy of 520 cases: surgical outcomes and comparing with laparoscopic single-site procedure. Surg Endosc. 2018;32(1):S351.CrossRef

57.

Angelos P. Can robotic approaches be justified for the benefit of surgeons? Surgery. 2017;161(3):639–40.CrossRefPubMed

58.

Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: results of a single-blinded randomized controlled trial. HPB. 2018;20:S726. https://doi.org/10.1016/j.hpb.2018.06.1466.CrossRef

59.

Lee EK, Park E, Oh WO, Shin NM. Comparison of the outcomes of robotic cholecystectomy and laparoscopic cholecystectomy. Ann Surg Treat Res. 2017;93(1):27–34. https://doi.org/10.4174/astr.2017.93.1.27.CrossRefPubMedPubMedCentral

60.

Higgins RM, Frelich MJ, Bosler ME, Gould JC. Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc. 2016;30:S243.

61.

Kitisin K, Packiam V, Celinski S, Chalikonda S, Pingpank J, Zeh H, et al. Is the ever-expanding scope of robotics safe for hepatobiliary surgery too? HPB. 2011;13:33.CrossRef

Title: Intraoperative and postoperative outcomes of robot-assisted cholecystectomy: a systematic review
Authors: Rivfka Shenoy
Michael A. Mederos
Linda Ye
Selene S. Mak
Meron M. Begashaw
Marika S. Booth
Paul G. Shekelle
Mark Wilson
William Gunnar
Melinda Maggard-Gibbons
Mark D. Girgis
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Cholecystectomy
Incisional Hernia
Published in: Systematic Reviews / Issue 1/2021
Electronic ISSN: 2046-4053
DOI: https://doi.org/10.1186/s13643-021-01673-x

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Systematic review registration

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Systematic review registration

Please log in to get access to this content

Other articles of this Issue 1/2021

The impact of different preanalytical methods related to CA 15-3 determination in frozen human blood samples: a systematic review

Effects of pollution on adolescent mental health: a systematic review protocol

The clinical effects of cerebral near-infrared spectroscopy monitoring (NIRS) versus no monitoring: a protocol for a systematic review with meta-analysis and trial sequential analysis

Visual impairment and medication safety: a protocol for a scoping review

Patient-reported outcome measures (PROMs) use in post-stroke patient care and clinical practice: a realist synthesis protocol

Vitamin D status and blood pressure in children and adolescents: a systematic review of observational studies