A Comparison of Robot-assisted Single Site and Laparoscopic Single-incision Cholecystectomy for Benign Gallbladder

A single-blinded randomized clinical trial (RCT) designed to compare Single-Site robot-assisted with single-incision laparoscopic cholecystectomy. The study directly compares both surgical approaches in a cohort of 60 patients (30 patients in each arm) with benign gallbladder disease from the Department of Surgery at the Cantonal Hospital of Winterthur (Kantonsspital Winterthur) in Switzerland. The primary endpoint of the study is the surgeon's physical and mental stress load at the time of surgery and is assessed by validated Local Experienced Discomfort (LED) and Subjective Mental Effort Questionnaire (SMEQ) visual analogue scales. The secondary endpoints include costs of the procedure, intra-operative blood loss, operating time, intra-operative conversion rate and additional trocar placement, complications, length of hospital stay, Health-Related Quality of Life (HRQoL) and cosmesis. HRQoL and cosmesis will be assessed using the validated Gastrointestinal Quality of Life Index (GIQLI) and the Body Image Questionnaires (BIQ), respectively. The inclusion criteria cover most notably symptomatic cholecystolithiasis, chronic cholecystitis, benign gallbladder polyps and age ≥18 years. The exclusion criteria are, among others, acute cholecystitis, emergency cholecystectomy, previous extensive upper abdominal surgery and suspicion of malignant disease. Non-stratified block randomization (random block sizes 2 and 4) will be used to achieve balance in the allocation of participants to both treatments arms and prevent a premature decoding of the randomization scheme. Hereby, the patient will not be informed about the group assignment until the last outpatient follow-up and only after he/she has completed and returned all required questionnaires (GIQLI and BIQ). The operation will be performed according to the group assignment by senior surgeons only who have a wide experience in both robotic Single-Site and conventional single-incision laparoscopy. All data are recorded safely using the SecuTrialTM program. Sample-size calculations are based on the results of the previously mentioned experimental setup by Schatte et al, utilizing an estimated effect size of 0.8, at a power of 0.8 and an alpha-error level of 0.05, as well as considering a potential additional error margin of 10-15% of the calculations (G-Power 3.1 software, Heinrich-Heine University Duesseldorf/Germany). The estimated total duration of the study is 1.5 years, including the scheduled 1-month and 1-year postoperative follow-up visits. The study will be carried out in accordance with principles enunciated in the current version of the Declaration of Helsinki, the guidelines of Good Clinical Practice (GCP) issued by International Conference on Harmonization (ICH), and Swiss regulatory authority's requirements.

Study Overview

• Status: Unknown
• Conditions: Benign Gallbladder Disease
• Intervention / Treatment: Device: Da Vinci Single Site Robot-Assisted Cholecystectomy; Device: Single Incision Laparoscopic Cholecystectomy

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Switzerland
  • Winterthur, Switzerland, 8401
    • Kantonsspital Winterthur

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patient compliance and geographic proximity allow proper preoperative checkup and postoperative follow-up
• Written informed consent given by the patient
• Women who are not breastfeeding and are not pregnant
• Age ≥18 years
• Symptomatic cholecystolithiasis
• Chronic cholecystitis
• Benign gallbladder polyps

Exclusion Criteria:

• Significant concomitant diseases making the patient unsuitable for abdominal surgery by the judgement of the physicians involved
• Peritoneal carcinomatosis or other extensive metastatic disease
• American Society of Anesthesiologists (ASA) IV and V patients
• Mental or organic disorders which could interfere with giving informed consent or receiving treatments
• Contraindications to pneumoperitoneum
• Suspicion of malignant disease
• Previous extensive upper abdominal surgery
• Acute cholecystitis
• Emergency cholecystectomy
• Obesity II°---III° (BMI>35.0 kg/m2)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Single-Site robot-assisted cholecystectomy	Device: Da Vinci Single Site Robot-Assisted Cholecystectomy
Active Comparator: Single-incision laparoscopic cholecystectomy	Device: Single Incision Laparoscopic Cholecystectomy

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Surgeon's comfort as measured by LED and SMEQ questionnaires	1 Day

Secondary Outcome Measures

Outcome Measure	Time Frame
Complications	1 year
Intra-operative blood loss	1 day
Operating time	1 day
Intra--operative conversion rate	1 day
Length of hospital stay	until discharge (average of 2 days)
Costs of procedure	until discharge (average of 2 days)
Health--Related Quality of Life (HRQoL)	1 year
Cosmesis as measured by Body Image Questionnaire (BIQ)	1 year
Intra-operative additional trocar placement	1 day

Collaborators and Investigators

• Sponsor: Kantonsspital Winterthur KSW
• Investigators: Principal Investigator: Stefan Breitenstein, MD, Kantonsspital Winterthur KSW

Publications and helpful links

General Publications

• Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial. Surg Endosc. 2019 May;33(5):1482-1490. doi: 10.1007/s00464-018-6430-7. Epub 2018 Sep 14.
• Grochola LF, Soll C, Zehnder A, Wyss R, Herzog P, Breitenstein S. Robot-assisted single-site compared with laparoscopic single-incision cholecystectomy for benign gallbladder disease: protocol for a randomized controlled trial. BMC Surg. 2017 Feb 9;17(1):13. doi: 10.1186/s12893-017-0206-1.

Study record dates

Study Major Dates

• Study Start: July 1, 2015
• Primary Completion (Actual): July 1, 2016
• Study Completion (Anticipated): July 1, 2017

Study Registration Dates

• First Submitted: February 19, 2015
• First Submitted That Met QC Criteria: June 25, 2015
• First Posted (Estimate): June 30, 2015

Study Record Updates

• Last Update Posted (Estimate): September 9, 2016
• Last Update Submitted That Met QC Criteria: September 8, 2016
• Last Verified: September 1, 2016

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Biliary Tract Diseases; Gallbladder Diseases
• Other Study ID Numbers: KEK-ZH 2014-0114