Original article| Volume 11, ISSUE 4, P882-885, July 2015

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Robotic single-site cholecystectomy in the obese: outcomes from a single institution

Published:November 25, 2014DOI:



      Robotic single-site cholecystectomy (RSSC) has been shown to be a safe alternative to the laparoscopic approach in selected patients. Patient exclusion criteria have prevented RSSC as a surgical option in many obese patients. This study reports the feasibility of performing RSSC in obese patients (body mass index [BMI]≥ 30).


      Between November 2012 and February 2014, a total of 200 patients underwent RSSC at our institution. All patients were offered the robotic procedure regardless of their BMI, age, previous surgery, and acuity of their disease with no exclusion criteria. All patients with BMI≥30 were included in the study and were compared to nonobese patients for demographic characteristics, co-morbidities, and postoperative outcomes. Data were compared to RSSC performed in nonobese patients by the same surgeon, as well to published data for standard laparoscopic cholecystectomy (LC).


      A total of 112 cholecystectomies were successfully performed with the robotic approach in patients with BMI≥30 without conversion to open, laparoscopic, or multiport procedures. The mean BMI was 39.5 (range 30.1–62.3). Twenty-eight patients had a BMI≥40 (25%), and 13 patients had a BMI≥50 (11.6%). Fifty-two patients (46.4%) had a history of prior abdominal surgery. Most procedures were nonelective (78.6%) with patients presenting with acute symptoms. Pathology showed chronic cholecystitis and cholelithiasis in 79 patients (70.5%), acute cholecystitis in 26 patients (23.3%), cholelithiasis in 4 patients (3.5%), and gangrenous cholecystitis in 3 patients (2.7%). Total mean operative time was 69.8 (26) minutes for obese patients compared to 59.2 (19.7) minutes in the nonobese, which was statistically significant (P = .0012). After a mean follow-up of 6 months, there were no major complications recorded including bile leak, hematoma, or ductal injury. There was 1 umbilical (incisional) hernia (0.9%) reported, and zero wound infections. When comparing RSSC performed in obese patients, RSSC in nonobese patients, and published data for standard LC, we found no difference in operative time, with less conversion to open.


      Robotic single-site cholecystectomy is a feasible option in the obese patient population with excellent short-term outcomes. Patients should not be excluded based on their high BMI although further study is needed to determine long-term outcomes.


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        • Schirmer B.D.
        • Edge S.B.
        • Dix J.
        • Hyser M.J.
        • Hanks J.B.
        • Jones R.S.
        Laparoscopic cholecystectomy, Treatment of choice for symptomatic cholelithiasis.
        Ann Surg. 1991; 213: 665-676
        • Morel P.
        • Hagen M.E.
        • Bucher P.
        • Buchs N.C.
        • Pugin F.
        Robotic single-port cholecystectomy using a new platform: initial clinical experience.
        J Gastrointest Surg. 2011; 15: 2182-2186
        • Pietrabissa A.
        • Sbrana F.
        • Morelli L.
        • et al.
        Overcoming the challenges of single-incision cholecystectomy with robotic single-site technology.
        Arch Surg. 2012; 147: 709-714
        • Tamini N.
        • Rota M.
        • Bolzonaro E.
        • et al.
        Single-incision versus standard multiple-incision laparoscopic cholecystectomy: a meta-analysis of experimental and observational studies.
        Surg Innov. 2014; 21: 528-545
        • Flegal K.M.
        • Carroll M.D.
        • Ogden C.L.
        • Johnson C.L.
        Prevalence and trends in obesity among US adults, 1999-2000.
        JAMA. 2002; 288: 1723
        • Paajanen H.
        • Kakela P.
        • Suuronen S.
        • Paajanen J.
        • Juvonen P.
        • Pihlajamaki J.
        Impact of obesity and associated diseases on outcome after laparoscopic cholecystectomy.
        Surg Laparosc Endosc Percutan Tech. 2012; 22: 509-513
        • Simopoulos C.
        • Botaitis S.
        • Karayiannakis A.J.
        • Tripsianis G.
        • Pitiakodis M.
        • Polychronidis A.
        The contribution of acute cholecystitis, obesity, and previous abdominal surgery on the outcome of laparoscopic cholecystectomy.
        Am Surg. 2007; 73: 371
        • Sidhu R.S.
        • Raj P.K.
        • Treat R.C.
        • Scarcipino M.A.
        • Tarr S.M.
        Obesity as a factor in laparoscopic cholecystectomy.
        Surg Endosc. 2007; 21: 774-776
        • Papandria D.
        • Lardaro T.
        • Rhee D.
        • et al.
        Risk factors for conversion from laparoscopic to open surgery: analysis of 2138 converted operations in the American College of Surgeons National Surgical Quality Improvement Program.
        Am Surg. 2013; 79: 914-921
        • Farkas D.T.
        • Moradi D.
        • Moaddel D.
        • Nagpal K.
        • Cosgrove J.M.
        The impact of body mass index on outcomes after laparoscopic cholecystectomy.
        Surg Endosc. 2012; 26: 964-969
        • Fourman M.M.
        • Saber A.A.
        Robotic bariatric surgery: a systematic review.
        Surg Obes Relat Dis. 2012; 8: 483-488
        • Sanchez B.R.
        • Mohr C.J.
        • Morton J.M.
        • Safadi B.Y.
        • Alami R.S.
        • Curet M.J.
        Comparison of totally robotic laparoscopic Roux-en-Y gastric bypass and traditional laparoscopic Roux-en-Y gastric bypass.
        Surg Obes Relat Dis. 2005; 1: 549-554
        • Marks J.
        • Phillips M.
        • Tacchino R.
        • et al.
        Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy.
        J Am Coll Surg. 2013; 216: 1037-1047
        • Wren S.M.
        • Curet M.J.
        Single-port robotic cholecystectomy: results from a first human use clinical study of the new da Vinci single-site surgical platform.
        Arch Surg. 2011; 146: 1122-1127
        • Vidovszky T.J.
        • Carr A.D.
        • Farinholt G.N.
        • Ho H.S.
        • Smith W.H.
        • Ali M.R.
        Single-site robotic cholecystectomy in a broadly inclusive patient population: a prospective study.
        Ann Surg. 2014; 260: 134-141
        • Youssef Y.
        • Lee G.
        • Godinez C.
        • et al.
        Laparoscopic cholecystectomy poses physical injury risk to surgeons: analysis of hand technique and standing position.
        Surg Endosc. 2011; 25: 2168-2174
        • Fransen S.
        • Stassen L.
        • Bouvy N.
        Single incision laparoscopic cholecystectomy: a review on the complications.
        J Minim Access Surg. 2012; 8: 1-5
        • Hernandez J.M.
        • Morron C.A.
        • Ross S.
        • Albrink M.
        • Rosemurgy A.S.
        Laparoendoscopic single site cholecystectomy: the first 100 patients.
        Am Surg. 2009; 75: 681-685
        • Podolsky E.R.
        • Rottman S.J.
        • Corcillo P.G.
        Single port access (SPA) cholecystectomy: two year follow-up.
        JSLS. 2009; 13: 528-535
        • Phillips M.S.
        • Marks J.M.
        • Roberts K.
        • et al.
        Intermediate results of a prospective randomized controlled trial of traditional four port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy.
        Surg Endosc. 2012; 26: 1296-1303
        • Joseph S.
        • Moore B.T.
        • Sorensen G.B.
        • et al.
        Single-incision laparoscopic cholecystectomy: a comparison with the gold standard.
        Surg Endosc. 2011; 25: 3008-3015
        • Erdas E.
        • Dazzi C.
        • Secchi F.
        • et al.
        Incidence and risk factors for trocar site hernia following laparoscopic cholecystectomy: A long-term follow-up study.
        Hernia. 2012; 16: 431-437
        • Comajuncosas J.
        • Hermoso J.
        • Gris P.
        • et al.
        Risk factors for umbilical trocar site incisional hernia in a laparoscopic cholecystectomy: a prospective 3-year follow-up study.
        Am J Surg. 2014; 207: 1-6