Please wait a minute...
Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (5): 792-796    DOI: 10.31083/j.ceog.2020.05.5441
Case Report Previous articles | Next articles
Robotic laparoendoscopic single-site surgery for concurrent hysterectomy and cholecystectomy
E.D. Na1, S.H. Choi2, H. Park1, *()
1Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnamsi, Gyeonggido, Republic of Korea
2Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnamsi, Gyeonggido, Republic of Korea
Download:  PDF(485KB)  ( 119 ) Full text   ( 6 )
Export:  BibTeX | EndNote (RIS)      
Abstract  

With the quality ergonomics and rapid learning curve of the robotic surgery system taken into consideration, robotic laparoendoscopic single-site surgery (R-LESS) appears to be the best integration for maximizing the benefits of single-site surgery. However, there are drawbacks of robot-assisted procedures which include longer operative time and higher cost, because of this, we hypothesized that the burden of robotic surgery would be reduced if two surgeries could be completed within one session in R-LESS. Three cases of R-LESS were performed for combined hysterectomy and cholecystectomy in patients with concomitant benign uterine disease and cholecystopathy. The combined surgeries were successfully conducted without additional port insertion or conversion and included the benefits of decreased hospital stay, anesthesia risk, and cost compared with the sum of two separate surgeries. Therefore, in cases in which concomitant pathologies are detected in the abdominopelvic cavity, R-LESS can be an option for selected patients with the benefit of minimally invasive surgery.

Key words:  Cholecystectomy      Hysterectomy      Robotic laparoendoscopic single site surgery     
Submitted:  07 November 2019      Accepted:  24 April 2020      Published:  15 October 2020     
*Corresponding Author(s):  H. Park     E-mail:  p06162006@cha.ac.kr

Cite this article: 

E.D. Na, S.H. Choi, H. Park. Robotic laparoendoscopic single-site surgery for concurrent hysterectomy and cholecystectomy. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 792-796.

URL: 

https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.05.5441     OR     https://ceog.imrpress.com/EN/Y2020/V47/I5/792

Figure 1.  — (A) Conventional laparoscopic port sites. (B) Robotic laparoendoscopic single-site surgery (R-LESS) central port site in the concurrent operation.

Table 1  — Characteristics and perioperative findings of patients.
Age (y) BMI (kg/m2) Clinical information Final histopathologies of specimens Operative finding Operative duration (h) Blood loss (mL) Postoperative hospital stay (d)
63 23.2 Previous conization with persistent HPV infection
Nausea and vomiting
Mild dysplasia and chronic cholecystitis Atrophic uterus with cervical os stricture 3.5 100 2
56 21.3 Acute right flank pain with hydronephrosis and chronic abdominal discomfort Uterine leiomyomas (120 g) and chronic cholecystitis with stones Leiomyoma of right uterine wall compressing the ureter 2.75 Minimal 5
49 24.1 Hypermenorrhea and postprandial discomfort Uterine leiomyomas (550 g) and chronic cholecystitis with stones Multiple leiomyomas, with the largest one having a diameter of 7 cm 3.42 250 4
[1] Kroh M., El-Hayek K., Rosenblatt S., Chand B., Escobar P., Kaouk J., Chalikonda S.: “First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform”. Surg. Endosc., 2011, 25, 73.
[2] Roh H.F., Nam S.H., Kim J.M.: “Robot-assisted laparoscopic surgery versus conventional laparoscopic surgery in randomized controlled trials: a systematic review and meta-analysis”. PLoS One, 2018, 13, e0191626.
doi: 10.1371/journal.pone.0191626 pmid: 29377956
[3] Navarra G., Pozza E., Occhionorelli S., Carcoforo P., Donini I.: “One-wound laparoscopic cholecystectomy”. Br. J. Surg., 1997, 84, 695.
pmid: 9171771
[4] Jeong S.Y., Lee J.W., Choi S.H., Kwon S.W.: “Single-incision laparoscopic cholecystectomy using instrumental alignment in robotic single-site cholecystectomy”. Ann. Surg. Treat. Res., 2018, 94, 291.
doi: 10.4174/astr.2018.94.6.291 pmid: 29854706
[5] Evers L., Bouvy N., Branje D., Peeters A.: “Single-incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy: a systematic review and meta-analysis”. Surg. Endosc., 2017, 31, 3437.
doi: 10.1007/s00464-016-5381-0 pmid: 28039641
[6] Migliore M., Arezzo A., Arolfo S., Passera R., Morino M.: “Safety of single-incision robotic cholecystectomy for benign gallbladder disease: a systematic review”. Surg. Endosc., 2018, 32, 4716.
pmid: 29943057
[7] Grochola L.F., Soll C., Zehnder A., Wyss R., Herzog P., Breitenstein S.: “Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial”. Surg. Endosc., 2019, 33, 1482.
doi: 10.1007/s00464-018-6430-7 pmid: 30218263
[8] Vizza E., Chiofalo B., Cutillo G., Mancini E., Baiocco E., Zampa A, et al.: “Robotic single site radical hysterectomy plus pelvic lymphadenectomy in gynecological cancers”. J. Gynecol. Oncol., 2018, 29, e2.
doi: 10.3802/jgo.2018.29.e2 pmid: 29185260
[9] Jung U.S., Choi J.S., Bae J., Lee W.M., Eom J.M.: “Systemic laparoscopic para-aortic lymphadenectomy to the left renal vein”. JSLS, 2019, 23, e2018.00110.
pmid: 31341378
[10] Hart S., Ross S., Rosemurgy A.: “Laparoendoscopic single-site combined cholecystectomy and hysterectomy”. J. Minim. Invasive. Gynecol., 2010, 17, 798.
doi: 10.1016/j.jmig.2010.07.006 pmid: 20955993
[11] Pluchino N., Buchs N.C., Drakopoulos P., Wenger J.M., Morel P., Dallenbach P.: “Robotic single-site combined cholecystectomy and hysterectomy: advantages and limits”. Int. J. Surg. Case. Rep., 2014, 5, 1025.
doi: 10.1016/j.ijscr.2014.10.001 pmid: 25460464
[12] Chung P.J., Huang R., Policastro L., Lee R., Schwartzman A., Alfonso A., et al.: “Single-site robotic cholecystectomy at an inner-city academic center”. JSLS, 2015, e2015.00033.
doi: 10.4293/JSLS.2020.00015 pmid: 32425482
[13] Iavazzo C., Minis E.E., Gkegkes I.D.: “Single-site port robotic-assisted hysterectomy: an update”. J. Robot. Surg., 2018, 12, 201.
doi: 10.1007/s11701-018-0789-2 pmid: 29453728
[14] Wang H., Zhou A., Fan M., Li P., Qi S., Gao L., et al.: “Application of laparoscopy in the combined surgical procedures of gynecological and digestive disorders in obese women: a retrospective cohort study”. Int. J. Surg., 2015, 16, 83.
doi: 10.1016/j.ijsu.2015.02.006 pmid: 25743389
[15] Palanivelu C., Ahluwalia J.S., Palanivelu P., Palanisamy S., Vij A.: “Combined surgical procedures using laparoendoscopic single-site surgery approach”. Asian. J. Endosc. Surg., 2013, 6, 165.
doi: 10.1111/ases.12023 pmid: 23464985
[1] Cengiz Andan, Serif Aksin, Mehmet Rifat Goklu, Seyhmus Tunc. Factors related to blood loss in laparoscopic hysterectomy[J]. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(5): 1075-1080.
[2] Eren Akbaba. Can high transverse skin incision (Modified Maylard) be a new alternative in placenta accreta spectrum management with cesarean hysterectomy?[J]. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(3): 686-690.
[3] Yuki Yoshimura, Kentaro Nakayama, Kiyoka Sawada, Hitomi Yamashita, Kohei Nakamura, Tomoka Ishibashi, Masako Ishikawa, Sultana Razia, Seiya Sato, Satoru Kyo. A case of rectal injury due to vaginal pipe misinsertion during total laparoscopic hysterectomy[J]. Clinical and Experimental Obstetrics & Gynecology, 2021, 48(1): 194-197.
[4] X.R. Wang, Y.F. Wang, S.W. Kang, Y. Zhang. Treatment outcomes of uterine lesion resection versus hysterectomy for cesarean scar pregnancy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(6): 882-886.
[5] O. Sevket, T. Takmaz, A.C. Sevket, A. Toprak, P. Ozcan. Vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC): technique and mean 20 months outcomes[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(6): 887-894.
[6] J.L. Liu, J.M. Chen, Y.F. Zheng, X.W. Zhang, R.X. Shi. 5 mm mini-incision laparoendoscopic single-site surgery of total hysterectomy: a report of five cases and literature review[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(6): 895-899.
[7] B. Kim, S.H. Hong, J.H. Kim, M.Y. Kang, M.R. Rhee, J. Kim, K.J. Kim, H.A. Lee. Giant ventral hernia immediately after vaginal twin delivery[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(6): 988-990.
[8] Ö. Koşar Can, Ö.T. Güler, Ü. Çabuş, D. Kılıç, C. Kabukçu. Evaluation of sexual functions and quality of life in female patients after hysterectomy for benign symptomatic diseases[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 693-700.
[9] P. Phangsuwan, P. Suprasert. Development of abnormal bowel function after simple hysterectomy[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(5): 744-748.
[10] K. Tamura, H. Takahashi, S. Uchida, M. Ogoyama, R. Usui, S. Matsubara. Intrauterine balloon failure: unrecognized placenta accreta spectrum disorders[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(3): 405-408.
[11] D. Jovanovic, D. R. Milovanovic, I. Jovanovic, M. Folic, V. Jakovljevic. Influence of cytokines on the postoperative period[J]. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 31-36.
[12] D. Damnjanovic, M. Zamurovic, D. Zamurovic, S. Krusic. Liver rupture as a complication in cardiopulmonary resuscitation for cardiac arrest after vaginal hysterectomy[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(6): 1031-1033.
[13] E. Chalari, G. Intas, S. Zyga, G. Fildissis, M. Tolia, N. Tsoukalas, A. Yfantis, G. Kyrgias, G. Panoutsopoulos. Preoperative factors affecting the intraoperative core body temperature in elective hysterectomy under general anesthesia[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(4): 560-564.
[14] K. Nakamura, K. Nakayama, T. Minamoto, T. Ishibashi, K. Sanuki, H. Yamashita, R. Ono, H. Sasamori, S. Razia, M.M. Hossain, S. Kamrunnahar, M. Ishikawa, S. Kyo. A novel retrograde approach for total laparoscopic hysterectomy in patients with severe adhesion in the cul-de-sac[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(4): 565-569.
[15] M. Simonsen, L. Martins Campbell, R. Moretti Marques. Uterine manipulator - low budget option[J]. Clinical and Experimental Obstetrics & Gynecology, 2019, 46(4): 575-577.
No Suggested Reading articles found!