Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA,
Surg Endosc. 2013 Dec;27(12):4524-31. doi: 10.1007/s00464-013-3105-2. Epub 2013 Aug 13.
Many series have shown the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC), but this technique still has limitations such as instrument collisions and lack of triangulation. Recently, two single-incision platforms, robotic and SPIDER, have attempted to ameliorate such problems. This study aimed to compare three different techniques of single-incision cholecystectomy: standard laparoscopic, robotic, and SPIDER approaches.
The authors retrospectively collected data from their first 166 single-incision robotic cholecystectomies (SIRCs) and compared the findings with the data from their first 166 SILCs and the first 166 s-generation SPIDER procedures. All the SILCs were performed with three trocars placed in one umbilical incision and with gallbladder retraction using a Prolene stitch on the right upper quadrant. All the robotic cases were managed using the da Vinci Single-Site Surgical System, and all the SPIDER procedures were performed using the SPIDER Surgical System.
The SILC, SIRC, and SPIDER groups consisted respectively of 129 (76.3%), 131 (78.9%), and 136 (81.9%) women with the respective mean ages of 44.5 ± 14.3, 51.6 ± 15.9, and 46.4 ± 15.2 years. The mean body mass indexes (BMIs) were respectively 29.1 ± 5.6, 29.4 ± 6.2, and 27.5 ± 4.8 kg/m(2), and the mean surgical times were 37.1 ± 13.3, 63.0 ± 25.2, and 52.8 ± 18.7 min. The total hospital stays were respectively 1.3 ± 5.3, 1.2 ± 2.2, and 1.5 ± 2.6 days, and complications were seen respectively in three SILC cases (1.8%), three SIRC cases (1.8%), and two SPIDER cases (1.2%).
The results of this study demonstrate similar results among the three platforms for most of the parameters measured. The SILC procedure appears to be superior to SIRC and SPIDER in terms of surgical time, but selection bias could be the cause. The SILS, SIRC, and SPIDER procedures all are similar in terms of complication profile. It can be concluded that SILC, SIRC, and SPIDER all are feasible and safe alternatives when used for single-incision cholecystectomy.
许多研究表明单切口腹腔镜胆囊切除术（SILC）具有可行性和安全性，但该技术仍存在器械碰撞和缺乏三角关系等局限性。最近，两种单切口平台，机器人和 SPIDER，试图改善这些问题。本研究旨在比较三种不同的单切口胆囊切除术技术：标准腹腔镜、机器人和 SPIDER 方法。
作者回顾性地收集了他们首次 166 例单切口机器人胆囊切除术（SIRC）的数据，并将结果与首次 166 例 SILC 和首次 166 例 s 代 SPIDER 手术的数据进行比较。所有 SILC 均采用三个套管针在一个脐部切口内进行，使用右上象限的 Prolene 缝线将胆囊缩回。所有机器人病例均采用达芬奇单部位手术系统进行管理，所有 SPIDER 手术均采用 SPIDER 手术系统进行。
SILC、SIRC 和 SPIDER 组分别由 129 例（76.3%）、131 例（78.9%）和 136 例（81.9%）女性组成，平均年龄分别为 44.5 ± 14.3、51.6 ± 15.9 和 46.4 ± 15.2 岁。平均体重指数（BMI）分别为 29.1 ± 5.6、29.4 ± 6.2 和 27.5 ± 4.8kg/m2，平均手术时间分别为 37.1 ± 13.3、63.0 ± 25.2 和 52.8 ± 18.7min。总住院时间分别为 1.3 ± 5.3、1.2 ± 2.2 和 1.5 ± 2.6 天，SILC 组有 3 例（1.8%）、SIRC 组有 3 例（1.8%）和 SPIDER 组有 2 例（1.2%）出现并发症。
本研究结果表明，在所测量的大多数参数中，三种平台的结果相似。SILC 手术在手术时间方面似乎优于 SIRC 和 SPIDER，但可能存在选择偏倚。SILS、SIRC 和 SPIDER 在并发症方面相似。可以得出结论，SILC、SIRC 和 SPIDER 都是用于单切口胆囊切除术的可行和安全的替代方法。
