Single-Site Gallbladder Surgery Means Fewer Scars, Faster Recovery

By Cheryl Olson, M.D., Scripps Health

More than 1 million Americans undergo gallbladder surgery every year. Yet relatively few people even really understand what the gallbladder does—or why it would need to be removed.

Located just below the liver, the gallbladder is a pear-shaped organ that stores a type of fluid called bile. Bile is produced by the liver, and helps your body digest fat. As you digest food, bile is released from the gallbladder through the common bile duct, a tube that connects your gallbladder and liver to your small intestine.

Most of the time, the gallbladder does its job with no problems. However, if the flow of bile through the ducts is blocked, the digestion process is disrupted. Most often, ducts are blocked by gallstones, which are small, pebble-like substances that develop when bile contains too much cholesterol or salt and becomes solid. Gallstone symptoms may include nausea, vomiting, or pain in the abdomen, back, or below your right arm.

Fortunately, you don’t really need your gallbladder. Bile can be passed to the small intestine through other paths. So if you have gallstone attacks or other problems with your gallbladder, often the best solution is simply to have it surgically removed. This procedure is called a cholecystectomy, and has generally been done either traditionally with a large incision under the rib cage, or laparoscopically with instruments placed into four to six small incisions made around the abdomen.

Recently, a new robotic operating platform for removing the gallbladder has enabled surgeons to use a single incision that is less than an inch long. Though surgeons had previously tried to do this surgery through a single site using regular laparoscopic instruments, most abandoned it because it was too difficult and required considerably more time.

Robotically assisted surgery, however, gives the surgeon much more control and dexterity. For example, the robot can “switch” instrument controls inside of the patient, enabling a right-handed surgeon to control the instruments with her dominant hand, even if the instrument is on the left side. This makes the procedure easier and more intuitive. The robotic system also provides the precision of three-dimensional, high definition vision.

In addition, because the robotic system enables the surgeon to operate through only one small incision via natural body opening like the navel, pain, scarring and recovery time are reduced.

The single-site surgery takes about an hour, which is comparable to the regular laparoscopic approach. This often includes an intraoperative cholangiogram, which allows the surgeon to view the anatomy of the bile duct system from the liver to the small intestine. During the cholangiogram, the surgeon places a small catheter tube into the cystic duct, which drains the gallbladder into the common bile duct. A dye is injected into the common bile duct and X-rays are taken to help the surgeon ensure there are no unexpected gallstones or other anatomic abnormalities, and that the common bile duct is not damaged during surgery.

Robotically assisted gallbladder surgery is an outpatient procedure that usually requires less than 24 hours in the hospital. It is most appropriate for patients who elect to have their gallbladders removed and have no complicating factors; if a patient is obese, or has complications such as acute cholecystitis (an inflamed gallbladder) this may not be an appropriate procedure. 

In addition to gallbladder surgery, robotically assisted single-site surgery is being used for some hysterectomy procedures. As the instruments progress in development, we expect to be able to do more procedures through a single incision, or a single incision plus one, rather than four or five incisions.

Cheryl Olson, M.D., is a general surgeon with Scripps. Dr. Olson will be hosting a free lecture on single site surgery that is open to the public at the La Jolla YMCA, (8355 Cliffridge Ave, La Jolla, CA 92037) on Sept. 25 at 11:30 a.m. For more information or a physician referral, call 1-800-SCRIPPS or visit www.scripps.org.