Single Site robotic Cholecystectomy: experience after 36 cases.

San Pio X Hospital, Milan – Italy

Jacques Mégevand, MD

Hospitals performing Single Site procedures in Europe

12 Centers in Italy

May 2013 May 2015

SSRC: Single Site Robotic Cholecystectomy

36consecutive patients were operated on with Single

Site (DaVinci Si) for gallstones.

Our Early Experience

First 2 caseswere tutored by an expert surgeon in Robotic Surgery

(G. Spinoglio, MD).

We performed all procedures with the same team because of the importance of coordination between the surgeon and the assistants.

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Our Early Experience

36 ptsWomen 22 pts (61%)Men 14 pts (39%)

Mean Age 53 yy (range 21 – 77 yy)

Patients characteristics

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Operative Time

Mean total operative time (TOT)

77 minutes (range 55-150 minutes)

Mean robotic time (RT)

48 minutes (range 20-70 minutes)

Mean docking time: (including port placement, patients positioning, and docking of patient cart)

15 minutes (range 10-30 minutes)

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Conversion rate

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Conversion to Open 1/36 (2.7%)Severe intraoperative

complications (Acute cystic arthery

bleeding)

Conversion to Laparoscopy 2/36 (5.5%) Chronic cholecystitis

Clinical outcomeHospital stay

All patients were discharged 2 days after procedure, except the two patients who underwent laparotomic conversion.

Morbidity

Wound infection 2.7 % (1/36)

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Cosmetic outcome

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Restricted lateral, upper and lower movements (close link with the camera)

Limitations for instruments (Hook, endowrist, absence of bipolar forceps,…...)

Careful dissection of the hilum for Hem-o-Lock placement

Conclusion

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Feasible with an accurate patient’s selection

Cosmetic outcome

ICG NIR-Fluorescence imaging

Conclusion

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Extension of surgical indications

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Conclusion

Right colectomiesLeft colectomies

Low anterior resectionHiatal ernia repair

Extension of surgical indications

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Conclusion

Right colectomiesLeft colectomies

Low anterior resectionHiatal ernia repair

Single Site Robotic Surgery

Chief. Jacques Mégevand, MD 

Andrea Rusconi, MDMassimo Amboldi, MDLeonardo Lenisa, MD

Ettore Lillo, MDRoberto Grignani, MD

Jacopo Catto Ronchino, MDSimona Borin, MDAnna Pertusati, MD

Staff of General Surgey Dep.