Summary:
Introduction: Laparoscopic approach profusely utilized in many surgical fields was enhanced by da Vinci robotic surgical
system in range of surgery wards, imprimis in the United States today. There was multispecialized robotic centre program initiated
in the Central Military Hospital in Prague in December 2005. Within the scope of implementing the da Vinci robotic system
to clinical practice we executed robotic-assisted laparoscopic cholecystectomy.
Methods: We have accomplished elective laparoscopic cholecystectomy using the da Vinci robotic surgical system.
Operating working group (two doctors, two scrub nurses) had completed certificated foreign training. Both of the surgeons have
many years experience of laparoscopic cholecystectomy. Operator controlled instruments from the surgeon’s console, assistant
placed clips on ends of cystic duct and cystic artery from auxiliary port after capnoperitoneum installation. We evacuated gallbladder
in plastic bag from abdominal cavity in place of original paraumbilical port. We were exploiting three working arms in
all our cases, holding surgical camera, electrocautery hook and Cadiere forceps. We had been observing procedure time, technical
complications connected with robotic system, length of hospital stay and complication incidence rate.
Results: We managed to finish all operations in laparoscopic way. Group of our patients formed 11 male patients (35.5%)
and 20 women (64.5%), mean aged 52.5 years in range of 27–77 years. The average operation procedure lasted 100 minutes,
in the group of last 11 patients only 69 minutes. We recorded paraumbilical wound
infections in 3 (9.7 %) patients. We had not experienced any technical problems with robotic surgical system. Length of hospital
stay was 3 days.
Conclusions: Considering our initial experience with robotic lasparoscopic cholecystectomy we evaluate da Vinci robotic
surgical system to be safe and sophisticated operating manipulator which however does not substitute the surgeon key-role of
controlling position and decision competences. Presented results of our group are comparable to conclusions of abroad published
works.
Key words:
laparoscopic cholecystectomy – robotic surgery – da Vinci system
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