First Hospital in the County to Remove Gallbladder using Single-Incision Robotic Technology

A surgical team at Doctors Community Hospital performed the first daVinci® Single-Site™ cholecystectomy in Prince George’s County in September. The patient’s gallbladder was removed through one tiny incision in the belly button, which resulted in a virtually scarless procedure.

Led by Hitesh Amin, MD, surgeon, the team removed the gallbladder using Single-Site™ instruments on the daVinci® Surgical System. This minimally invasive procedure is traditionally called a laparoscopic cholecystectomy (removal of the gallbladder). Using robotic assistance, Dr. Amin removed the gallbladder through a single incision in the belly button instead of the three to five small incisions sometimes required with traditional laparoscopic surgeries.

The Food and Drug Administration cleared the specialized Single-Site instruments for use with the daVinci Surgical System in December 2011.

"Neither robotic-assisted surgery nor single-incision surgery is new, but combining the two to remove the gallbladder requires additional training and special equipment," says Dr. Amin. "With single-site surgery, my patients go home with almost no visible scars and quickly get back to their daily lives.  I use the daVinci robot as a means by which to safely offer this virtually scarless procedure to my patients.”

In addition to minimized scaring, other potential benefits of single-site gallbladder surgery includes  reduced pain, low blood loss, fast recovery, a short hospital stay and high patient satisfaction.

During the procedure, the surgeon sits comfortably at a console and views a 3D, high-definition image of the patient’s anatomy. The surgeon uses controls below the viewer to move the instrument arms and camera.  In real-time, the system translates the surgeon's hand, wrist and finger movements into more precise movements of the miniaturized instruments inside the patient.

Most people who require gallbladder removal are candidates for the robotic-assisted, single-incision surgery. According to the American College of Surgeons, surgery is the recommended treatment for gallbladder pain from gallstones to non-functioning gallbladders.

More than 1 million people in the U.S. have their gallbladders removed each year. In the Washington metropolitan area, an estimated 13,000 gallbladder procedures are performed annually – including about 1,500 in Prince George’s County.  Most are performed with traditional laparoscopy, which results in multiple incisions.

Potential risks include conversion to other surgical techniques and multiple incisions. All surgery presents risk, including daVinci surgery. Serious complications may occur in any surgery, up to and including death.  Other risks include injury to tissues and organs. Risks specific to gallbladder surgery, including surgery with da Vinci, include pancreatitis (inflammation of the pancreas), urinary retention and hernia (bulging tissue) at the incision site.

In addition to gallbladder removal, Doctors Community Hospital was the first hospital in Prince George’s County to provide bariatric surgeries using the daVinci robot – giving residents a weight loss surgical option that often results in reduced scarring, pain and hospitalization. 

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With a tradition of providing high-quality and comprehensive medical services, Doctors Community Hospital is dedicated to passionately caring for its patients and community. Founded in 1975, this non-profit institution is an acute-care medical and surgical hospital with 219 licensed beds. Along with primary care services and advanced robotic surgery technology, some of the hospital’s other programs include:

+ Bariatric and Weight Loss Center

+ Capital Orthopaedic Specialists

+ Cardiology Services

+ Center for Ear, Nose and Throat

+ Center for Wound Healing and Hyperbaric Medicine

+ Center for Comprehensive Breast Care

+ Emergency Department

+ Imaging Services

+ Joslin Diabetes Center

+ Outpatient Rehabilitation Services

+ Sleep Center

+ Spine Team Maryland

Sources:

Kroh M, El-Hayek K, Rosenblatt S, Chand B, Escobar P, Kaouk J, Chalikonda S. First human surgery with a novel single-port robotic system: cholecystectomy using the da Vinci Single-Site platform. Surg Endosc. 2011 Nov;25(11):3566-73. Epub 2011 Jun 3.

Haber GP, White MA, Autorino R, Escobar PF, Kroh MD, Chalikonda S, Khanna R, Forest S, Yang B, Altunrende F, Stein RJ, Kaouk JH. Novel robotic da Vinci instruments

Wren SM, Curet MJ. Single-port robotic cholecystectomy: results from a first human use clinical study of the new da Vinci single-site surgical platform. Arch Surg. 2011 Oct;146(10):1122-7. Epub 2011 Jun 20.

US Department of Health and Human Services. Health, United States, 2009. In Brief – Medical Technology. http://www.cdc.gov/nchs/data/hus/hus09_InBrief_MedicalTech.pdf. p. 8.

American College of Surgeons. Cholecystectomy: Surgical Removal of the Gallbladder. http://www.facs.org/public_info/operation/cholesys.pdf

National Institutes of Health. Gallbladder Removal Surgery. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/002930.htm

da Vinci Surgery with Single-Site™ Instruments is cleared for use in gallbladder removal, and for hysterectomy and ovary removal for benign conditions. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery with Single-Site™ Instruments. The safety and effectiveness of this device for use in the performance of general laparoscopic abdominal surgery procedures have not been established.

All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary.  Serious complications may occur may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include damage injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risk specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to an open approach; or the need for additional or larger incision sites.  Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/safety.

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