Outcomes in Single-port Versus Multiport Robotic Cholecystectomy: A Systematic Review of the Literature

Abstract

Background: Single incision laparoscopic surgery (SILS) had initially gained significant traction due to safety and feasibility that were comparable, in addition to the cosmetic advantages over traditional laparoscopy. However significant limitations of SILS including narrow working space and poor triangulation, lead to longer operating times [1]. Due to these limitations most of the surgical community have reverted back to traditional four-port laparoscopy for cholecystectomy. After the introduction of the robot, the multiport (MP) platform was the initial method used for cholecystectomy. The robotic single-site (SP) surgery platform is proposed to overcome some of the limitations of SILS while maintaining its benefits.  Objectives: We present a systematic review comparing clinical outcomes of multiport versus single-port (SP) robotic cholecystectomy for the treatment of benign gallbladder disease. Materials/Patients and Methods: Key words “Robotic”, “Robotic assisted”, “daVinci robot”, “daVinci robot assisted”, and MeSH terms “cholecystectomy”, “gallbladder”, “biliary”, “cholelithiasis” were searched on Medline, Embase and Cochrane databases, to acquire citations between 1980 and 2012. Two treatment arms were identified: single port (SP) and multiport (MP). Variables considered included age, gender, BMI, operating time, conversion to open, complications and mortality. Primary outcomes include; thirty day mortality, thirty day morbidity, and conversions to traditional laparoscopy or laparotomy. The secondary outcome measure was operative time.  Demographics analyzed included age, sex, and body mass index (BMI). Results: The initial search revealed two hundred and fifty five citations. Exclusion based on title criteria revealed seventy five articles. Twenty-two articles fulfilled further inclusion criteria. The SP arm included two hundred cases (six articles) and MP included three hundred and eighty three cases (sixteen articles). Pooled mean (PM) ages were 50.16 years and 47.38 years for SP and MP. BMI was 28.16 Kg/M2 (SP) vs. 28.24 Kg/M2 (MP). Operating times were longer in the SP group, (92.94 minutes vs. 91.13 minutes). Complication rate of 5/200 in SP group vs. 13/383 in MP group were found, and overall mortality was zero for both. Conclusions: Single incision robotic cholecystectomy appears to be comparable to multiport robotics in terms of safety and feasibility, however larger studies, randomized, need to be conducted for more statistically significant data. Implication for Health Policy Makers/Practice/Research/Medical Education: An understanding of the outcomes between standard multiport and single-port robotic cholecystectomy will guide further research and quality improvement with respect to cost-effectiveness of certain robotic procedures.