Robot-assisted laparoscopic cholecystectomy. A new learnt technique

The objective was to review an experience with robot-assisted laparoscopic cholecystectomy. We reviewed prospectively 28 cholecystectomies performed with the assistance of a surgical robot at the Cedars Sinai Medical Center in California, from august 4 to October 1, 2006. The gallbladder was removed by the surgeons with the use of the robot. The total operating time, assembly time of the robot, complications, and postoperative course were evaluated. 28 patients underwent robot-assisted laparoscopic cholecystectomy; 25 had symptomatic cholelithiasis, 2 had gallbladder polyps, and one had acute cholecystitis. All of the 28 surgeries were completed successfully with robot assistance. In three consecutive patients, a mechanical problem occurred with the robot; however, all procedures were completed laparoscopically. The mean set-up time, including patient positioning and preparation and robotic installation, was 25,1+-3,5 minutes. The mean +- SD operating time was 62,5+-12,6 minutes without a cholangiogram and 92+-15,9 minutes with a cholangiogram. There were not complications and no conversions to an open procedure. Robotic surgery offers many potential advantages, including surgeon comfort, elimination of surgeon tremor, improved imaging, and increased degrees of freedom of the operative instruments, compared with conventional laparoscopic surgery. However, patients outcomes and operative costs need to be evaluated.