First experiences with robotic-assisted laparoscopic cholecystectomies

Background: The recent introduction of surgical robotic systems marks a new milestone in surgical medicine comparable to the laparoscopic approach in the late 1980s. At Innsbruck University Hospital we have been using the da Vinci™ robotic system (Intuitive Surgical, Mountain View, CA, USA) since June 2001. Our first general surgical experiences with this device and laparoscopic cholecystectomies are reported here. Methods: The da Vinci™ robot is a supervised on-line system in which the surgeon at a remote console controls the endoscopic instruments and a binocular 3-D videoscope via three robotic arms. A scrubbed 'conventional' team consisting of at least one surgeon and a nurse assists the procedure to change the robotic surgical instruments as well as to allow immediate conversion to a conventional laparoscopic or open procedure, if necessary. During the first 6 months, 25 cholecystectomies were performed using the da Vinci™ surgical robot. Results: Two out of 25 cholecystectomies had to be converted to conventional laparoscopy due to system break-down. Two intraoperative complications were managed successfully, and one redo-operation was necessary because of postoperative bleeding at a port site. Operating time was 100 (60-171) min with a duration of 52 (35-99) min for the robot-assisted act itself. Postoperative results and hospitalization times did not differ from conventional laparoscopic procedures. Conclusions: Laparoscopic cholecystectomy can be performed with the surgical robotic da Vinci™ system as safely as with the conventional laparoscopic approach. The longer operating time is mainly due to the learning curve and the time-consuming installation of the robot itself. Laparoscopic cholecystectomy is the ideal procedure for learning and teaching robot-assisted operations in general surgery. Although the present limitations of the system are evident (cumbersome equipment, lack of special instruments, only two working arms) we feel ready to perform more complex procedures in the near future.