Robotic Cholecystectomy: Preliminary Experience and Future Perspectives

Background: The main advantages of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice and robotic cholecystectomy represents the operation of choice for general surgeons to acquire clinical da Vinci experience. Methods: Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci-Xi training course and agreed to work together on all procedures. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the Secondary outcome was learning curve. Results: There were 10 procedures in the robotic arm and 15 in the laparoscopic Arm. One complication (port-site hernia) occurred in the laparoscopic arm, and only one robotic patient (surgical wound infection) experienced a complication. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (70 v. 40 min, p < 0.001) due to the docking of da Vinci system. The mean time to clear the operating room was significantly longer for robotic procedures (20 v. 11 min, p = 0.015). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (80 v. 66 min, p<0,05). Conclusion: Our experience can suggest that robotic cholecystectomy is one means by which general surgeons may gain confidence in performing advanced robotic procedures and it confirms the reliability of this training course.