Robotic Cholecystectomy: Preliminary Experience and Future Perspectives.

Background: The main advantages of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice and robotic cholecystectomy represents the operation of choice for general surgeons to acquire clinical da Vinci experience. Methods: Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci-Xi training course and agreed to work together on all procedures. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the Secondary outcome was learning curve. Results: There were 10 procedures in the robotic arm and 15 in the laparoscopic Arm. One complication (port-site hernia) occurred in the laparoscopic arm, and only one robotic patient (surgical wound infection) experienced a complication. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (70 v. 40 min, p < 0.001) due to the docking of da Vinci system. The mean time to clear the operating room was significantly longer for robotic procedures (20 v. 11 min, p = 0.015). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (80 v. 66 min, p