Journal Mobile Options
Table of Contents
Vol. 22, No. 6, 2005
Issue release date: April 2006
Dig Surg 2005;22:426–431

First Results after Introduction of the Four-Armed da Vinci Surgical System in Fully Robotic Laparoscopic Cholecystectomy

Heemskerk J. · van Dam R. · van Gemert W.G. · Beets G.L. · Greve J.W.M. · Jacobs M.J.H.M. · Bouvy N.D.
Department of Surgery, Maastricht University Hospital, Maastricht, The Netherlands

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Laparoscopic cholecystectomy offers less post-operative pain, less complications, and faster recovery compared with open cholecystectomy. However, laparoscopic surgery can be demanding because of several technical drawbacks. Robotic surgery allows dexterity skills to be performed faster and shortens the learning curve, possibly leading to faster and safer laparoscopic surgery. Methods: In this paper, we report the results of our first 12 cases of fully robotic laparoscopic cholecystectomy using the da Vinci Surgical System, comparing them with 12 cases of conventional laparoscopic cholecystectomy. Using a fourth arm in robotic laparoscopy enables the surgeon to perform surgery without the use of a tableside assistant, leading to non-tiring, tremble-free assistance and reducing salary costs. Primary end points are operating time and costs. Secondary end points are operative complications and duration of admission. Results: Fully robotic cholecystectomy was completed in all 12 cases without increased complication rate and without conversions. However, robotic assistance results in an increased overall operating room stay of 31 min and increased costs of EUR 1,180.62. Conclusion: Fully robotic laparoscopic cholecystectomy is safe and feasible but seems more expensive and time consuming at this moment.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Bass EB, Pitt HA, Lillemoe KD: Cost-effectiveness of laparoscopic versus open cholecystectomy. Am J Surg 1993;165:466–471.
  2. Boerma D, Rauws EA, Keulemans YC, et al: Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial. Lancet 2002;360:761–765.
  3. Kiviluoto T, Siren J, Luukkonen P, et al: Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 1998;351:321–325.
  4. Koperna T, Kisser M, Schulz F: Laparoscopic versus open treatment of patients with acute cholecystitis. Hepatogastroenterology 1999;46:753–757.
  5. Berggren U, Gordh T, Grama D, et al: Laparoscopic versus open cholecystectomy: hospitalization, sick leave, analgesia and trauma responses. Br J Surg 1994;81:1362–1365.
  6. Calvert NW, Troy GP, Johnson AG: Laparoscopic cholecystectomy: a good buy? A cost comparison with small incision (mini) cholecystectomy. Eur J Surg 2000;166:782–786.
  7. Brazier JE, Johnson AG: Economics of surgery. Lancet 2001;358:1077–1081.
  8. Voitk AJ, Tsao SG, Ignatius S: The tail of the learning curve for laparoscopic cholecystectomy. Am J Surg 2001;182:250–253.
  9. Yohannes P, Rotariu P, Pinto P, Smith AD, Lee BR: Comparison of robotic versus laparoscopic skills: is there a difference in the learning curve? Urology 2002;60:39–45.
  10. Hernandez JD, Bann SD, Munz Y, et al: Qualitative and quantitative analysis of the learning curve of a simulated surgical task on the da Vinci system. Surg Endosc 2004;18:372–378.
  11. Giulianotti PC, Coratti A, Agelini M, et al: Robotics in general surgery: personal experience in a large community hospital. Arch Surg 2003;138:777–784.
  12. Roeyen G, Chapelle T, Ysebaert D: Robot-assisted choledochotomy: feasibility. Surg Endosc 2004;18:165–166.
  13. Undre S, Munz Y, Moorthy K, et al: Robot-assisted adrenalectomy: preliminary UK results. BJU Int 2004;93:357–359.
  14. Nio D, Bemelman WA, Busch OR, et al: Robot-assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a comparative study. Surg Endosc 2004;18:379–382.
  15. Ruurda JP, Broeders IA, Simmermacher RP, et al: Feasibility of robot-assisted laparoscopic surgery: an evaluation of 35 robot-assisted laparoscopic cholecystectomies. Surg Laparosc Endosc Percutan Tech 2002;12:41–45.
  16. Ruurda JP, Visser PL, Broeders IA: Analysis of procedure time in robot-assisted surgery: comparative study in laparoscopic cholecystectomy. Comput Aided Surg 2003;8:24–29.
  17. Delaney CP, Lynch AC, Senagore AJ, et al: Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 2003;46:1633–1639.
  18. Sarle R, Tewari A, Shrivastava A, et al: Surgical robotics and laparoscopic training drills. J Endourol 2004;18:63–66.
  19. Newlin ME, Mikami DJ, Melvin SW: Initial experience with the four-arm computer-enhanced telesurgery device in foregut surgery. J Laparoendosc Adv Surg Tech A 2004;14:121–124.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50