Minimally Invasive Single-Site Cholecystectomy in Obese Patients: Laparoscopic vs. Robotic.

Robotic single-site cholecystectomy (RSSC) has emerged as an alternative procedure to overcome the shortcomings of single-fulcrum laparoscopic cholecystectomy in terms of the ergonomics and reducing the physical and mental stress of the surgeon. It is also necessary to assess the safety of RSSC for obese patients in a world with an increasing population of obese people. RSSC took a longer operation time, but the actual dissection time was similar to that of single-fulcrum laparoscopic cholecystectomy. There was no difference in postoperative pain, except for during the immediate postoperative period, and in the length of the hospital stay. RSSC had the advantage of reducing the incidence of intraoperative iatrogenic gallbladder perforation. It is critical to prevent any intraoperative bile leakage, which is associated as a worse prognostic factor in those patients with gallbladder cancer. Additional studies with a prospective design and larger number of study subjects will be required to confirm the safety and feasibility of RSSC. Moreover, the cost benefit and safety for treating malignant lesions are also issues to be addressed. RSSC is expected to be further expanded as an operative mode in the future.