Abstract
Background
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).
Methods
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).
Results
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.
Conclusions
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.
Keywords
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Article info
Publication history
Published online: November 25, 2014
Accepted:
September 20,
2014
Received:
September 9,
2014
Identification
Copyright
© 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
