Robot-assisted laparoscopic surgery. Preliminary results at our Center

The aim of our study was to evaluate the advantages and disadvantages of robot-assisted laparoscopic surgery, in terms of operative times, complications and length of hospital stay, using the Da Vinci Robotic Surgical System (Intuitive Surgical, Inc.). Twenty-five patients underwent robotic procedures. The indications were gastro-oesophageal reflux disease in 13 cases, achalasia in 2, cholelithiasis in 2, adrenal adenoma in Cushing syndrome in 6, pheochromocytoma in 2, and incidentaloma in 1. Robotic surgery was compared with the traditional laparoscopic approach. From January to September 2002 13 Nissen-Rossetti fundoplications, 2 Heller myotomies with Dor fundoplication, 2 cholecystectomies and 9 adrenalectomies (6 left adrenalectomies, 3 right adrenalectomies) were performed. There were no significant differences in age, preoperative body mass index (mean 28; range: 18-32) or sex between patients treated by robotic surgery and those treated by traditional laparoscopy. Operative times were significantly longer in the robotic surgery group (97.1 minutes, range: 77-126 minutes, versus 82.5 minutes, range: 65-100 minutes, for Nissen-Rossetti fundoplication; 132.8 minutes, range 104-181 minutes, versus 82.1 minutes, range 55-120 minutes, for adrenalectomy). There were no intraoperative complications. Conversion to traditional laparoscopy was necessary owing to technical difficulties in 4/9 adrenalectomies (44.4%; 3 left, 1 right). There was no significant difference in length of hospital stay (3.2 days, range 2-7 days, for Nissen-Rossetti fundoplication; 5.7 days, range 4-9 days, for adrenalectomy). Our study confirms the safety and feasibility of robot-assisted laparoscopic surgery. However, operative times were longer and costs higher, with no difference in outcomes. Given the current level of technology and experience, robotic surgery would not appear to afford any advantage over standard laparoscopic approaches.