Single-site robotic cholecystectomy versus four-port laparoscopic cholecystectomy in patients with cholelithiasis or gallbladder polyps: a prospective, randomized, double blind study.

None listed

Randomized studies have failed to demonstrate significant outcome benefit after single-incision laparoscopic cholecystectomy when compared to conventional laparoscopic cholecystectomy. The new robotic single-site platform allows improved stability of instruments and smoother dissection, which might reduce tissue trauma with potential positive effects on local inflammation and postoperative pain. Two groups of 30 eligible patients were randomized to receive either SIRC or CLC. During the first postoperative week, patients and study monitors were blinded to the type of procedure performed by the application of four pieces of dressing tape at the end of surgery. Site-specific pain was assessed 6 hours postoperatively, and at one, seven and thirty days after surgery, when a 1 to 10 cosmetic score was also administered to patients. Primary endpoint was 50% pain reduction at 24 hours after surgery in single-site robotic group versus conventional laparoscopic group. Secondary endpoint were post-operative pain trend over time based on "total VAS" (the sum of the VAS rates on each abdominal access site) and site-specific VAS values at 6 hours, 24 hours, 7 and 30 days post-operatively and cosmetic result measured with a 0-10 patient satisfaction scale at 30 days after surgery. Results of this trial showed that single-site robotic technique does not offer any significant reduction of post-operative pain when compared to the conventional laparoscopic procedure. The cosmetic advantage of the single-site robotic approach is balanced by an increased risk of incisional hernias and higher costs.